Now that I’ve gotten your attention, it is actually a Forbes writer who wants to block grant Medicaid and allow states to conduct explicit cost effectiveness decisions for what treatments Medicaid will fund. Those decisions will lead to numerous early deaths.
an advisory board recommended that Arkansas’s Medicaid program cover Kalydeco, a cystic fibrosis drug whose…net cost to the state Medicaid program will only be $239,000 per patient year….the state is being sued on grounds that its policy violates a federal statute requiring state Medicaid programs to pay for all medically necessary treatments. This case illustrates some deep flaws in current Medicaid policy….
The WHO considers a medical intervention to be “not cost-effective” if it costs more than three times a nation’s per capita GDP per year of life saved. With U.S. GDP per capita currently at $51,749, it is pretty obvious that $239,000 lies pretty far outside the bounds of what WHO would deem cost-effective. If the WHO criteria are viewed as legitimate enough for entire nations to decide what tax-financed national health programs should cover, why should it be illegitimate for state Medicaid programs to adopt similar thresholds?
I’ve written about Kalydeco before as it is an excellent case study of specialty drug pricing and policy implications. Compared to the next best alternative, it is an amazing treatment in both prolonging life and dramatically improving the quality of life. It is also on patent and will be a quarter million dollar a year drug for life. Until it is off patent, treating a CF patient from birth to eighteen is a five million dollar tab. Most insurers will pick up the cost and then aggressively do everything possible to get that patient to be someone else’s problem next year. Medicaid entities are the payers of last resort and will pay as well.
We could have a discussion about the legitimacy of cost effectiveness decisions if this country did not have a massive fact free freak out stoked by Connover and his ideological ilk about Medicare paying for a doctor to discuss end of life treatment possibilities with patients. A Republican proposal inserted into PPACA’s draft stages to allow people to make more fully informed decisions while not asking experts to donate their time became death panels. PPACA established research centers that were forbidden from applying long division on comparative effectiveness research to determine cost effectiveness. All of one political party opposed cost effectiveness decision making or even knowledge creation the last time this was up for debate, and a significant chunk of the other party was either squeamish or fearing for their political lives about introducing a hard no based on cost or effectiveness into the system.
Now we could have this type of discussion if there are other no’s introduced into the system. If Medicare/Mediciad was allowed to negoatiate, if Medicare/Medicaid was allowed to tell a provider that their drug was to be off the formularies entirely at a price point, if the specialty drugs could be reduced in price to a point where there is no longer massive rentier profits. Now if we could have those policies in place where the cost effectiveness decision was based on at least the average cost of a treatment and not the rentier/monopolostic profits of a treatment, then that is a disucssion that could be worth having. Until then, cost effectiveness decisions for extreme outlier cases basically means a death sentence.
Cystic Fibrosis is a quarter to half a million dollar a year diagnosis. Hemophilia is a multi-million dollar a year diagnosis. Does Chris Connover want to say “tough luck, you lost the genetic lottery, go die quietly in the corner…” to a hemophiliac and his family? I will post the bail money after he is punched in the face if I am allowed to watch the conversation.
rlrr
“It only effects the poor, so what’s the problem?”
— The GOP
greennotGreen
So the same party that backs the forced birthers wants to tell parents of the ex fetuses (babies) that their children are now too expensive to keep alive?
I would rather we have a model where even a larger portion of medical research were funded by us all, but we don’t. At a certain point we turn it over to for-profits, and they have to make a profit, hence Kalydeco’s steep price. However, other drug companies have looked at that juicy profit and now they’re jumping into CF research. Soon there will be other drugs from other manufacturers, there will be competition, the prices will go down, and someday people who lose the roll of the genetic dice won’t be consigned to an early death.
Full disclosure: my 26yo nephew has CF. He is a sweet and thoughtful young man unlike the sociopath who wrote the article in Forbes.
Tinare
Wait, so he’s advocating in favor of death panels, right?
rikyrah
Dude,
this is who they are. OF COURSE, they want Death Panels for the poor.
Baud
Does the author argue the converse: That the country has a moral obligation to cover all medical issues that fall under whatever cost-effectiveness threshold makes sense?
Somehow, I doubt it.
MomSense
@rikyrah:
Contrary to the GOP talking heads on Morning Joe and the rest of cable news, the President can’t sway the Republicans with cocktails and schmoozing and leadering. The Republicans are evil mother fuckers who do not care at all about the lives and well being of human beings who are not them, their family or their benefactors in this country or any other. I don’t believe for a second that they care about fetuses and zygotes except that they serve as effective ways to manipulate voters. The reason I know they don’t care at all about them is that once they are born they could care less if they go hungry, uneducated, or die from lack of access to health care.
They dress up their evil by saying that they are trying to break the “culture of dependency” or some other bullshit but that is just the 21st century way of saying “let them eat cake”.
Soprano2
My employer had a retiree who was a hemopheliac; he was forced into the high risk pool because we are self-insured and they didn’t want to raise the lifetime cap above $2 million. Of course I think all that is irrelevant at this point, but it wasn’t several years ago.
Southern Beale
So it appears ATT Uverse just got hacked or something? Uverse customers watching Al Jazeera America just had their channels changed on them — I can’t override it, my remote isn’t working — to The Today Show (non-HD version, no less). We got a message saying it was “at the request of the White House” and then a periodic message that say “This is an emergency action notification. Your channel has been force tuned to receive the emergency message.” But there’s no message. Just the fucking Today Show.
I’m creeped out 10,000 different ways right now.
lol
@Southern Beale:
Probably not a hack, just some tech who done fucked up.
Baud
@lol:
Yeah, sounds like someone triggered the emergency alert system.
MomSense
@Baud:
But the emergency alert system wouldn’t direct you to a message from the White House unless……it was something like Obama has finally given the ok to the martians he trained with back when he was part of that super secret CIA mission to Mars to bring back lizard people…
Now I’m freaked the fuck out, too.
/tin foil hat
greennotGreen
@Southern Beale: I get the same Emergency Alert, but I notice the call letters are NSHVLTN101 or something like that. Any U-verse subscribers out there who aren’t in Middle Tennessee? I’ll bet this is a local problem. The NPR affiliate hasn’t interrupted their pledge drive, so I don’t think there’s actually an emergency.
scav
Sister Rail Gun of Warm Humanitarianism
@greennotGreen:
Yes.
Yes. Not happening in Raleigh NC.
OTOH, there are some right wing fora that are freaking out right now because some of them were force tuned to NBC from Fox.
boatboy_srq
In other words, it’s all about keeping healthcare expensive, and then making sure that only the right kind of people could afford it. Social engineering at its most Darwinian. Who says the Reichwing doesn’t accept evolutionary theory?
@Tinare: He is, but only for the unRighteous (identified through their being unHealthy). So for the Deserving, he isn’t – but for the rest…
Rob in CT
Republican objections to the idea of rationing health care (“death panels”) was never about the concept itself, but rather the idea that it would be applied regardless of wealth.
As we all know, the pre-ACA (and post-ACA, but to a lesser extent) US healthcare/insurance system rations – by ability to pay. Republicans are fine with this.
ericblair
@greennotGreen:
I don’t think the NPR affiliate would interrupt their pledge drive even if there was a full scale nuclear exchange, so that doesn’t tell you anything.
No, the lizard people are going to land in Mexico any minute and swarm over the border while Teh Ebolas wipe out all the patriotic/white and heavily armed rednecks who could stop them. The Secret Service will then let them walk right into the White House where they will institute soshulist Sharia law and universal healthcare.
But if you’re nice to me I can get you a cushy overseer job in the dilithium mines and not end up as Gluten-Free Soylent Lite.
daveNYC
@greennotGreen:
You underestimate the power of the NPR pledge drive.
Villago Delenda Est
Yes. Yes he does.
PurpleGirl
@ericblair:
But if you’re nice to me I can get you a cushy overseer job in the dilithium mines and not end up as Gluten-Free Soylent Lite.
Brilliant. Thanks for a laugh.
Seanly
@ericblair:
The lizard people are offering universal healthcare? I’ll take it and run the risk of being reduced to a protein drink for them.
Rob in CT
At some point, we have to look at cost-effectiveness. Scarcity of resources is a real thing, and likely always will be. It’s politically useful to pretend this isn’t so, and that the “no” only comes about because of your dastardly opponents. But that’s bullshit. The question is how we do this. One some level, we all understand this. Generally, Right-wingers want to do it based on wealth and Left-wingers want to do it regardless of wealth (though the truly wealthy will always be able to buy themselves whatever, and frankly some of that will spur innovation so I’m fine w/it). But eventually, in some way, the system has to be able to say no.
JPL
@greennotGreen: Earlier my son told me on chat, that the same thing happened in the Atlanta area. He’s working from home and is not a happy camper.
AT & T could blame Obama and twenty seven percent would believe them.
scav
Oh, that canny free market, possibly being all totally cost-effective, all highest-and-best-use of funds and not pushing through testing of an ebola vaccine until the right kind of price-point customers needed it. Having a large, captive and active pool of desperate, entirely disposable volunteers for testing available? Double-win for Team Invisible Hand! Entirely enjoying the grace note of comparing Canadia and TX-style actions again.
JPL
@Rob in CT: There’s always been questions about whether or not you treat cancer in a person who is over ninety. Seems to me that the quality of life question should be considered.
greennotGreen
@Rob in CT: “Right-wingers want to do it based on wealth and Left-wingers want to do it regardless of wealth.”
And this is applicable to the abortion rights fight, as well. The rich Powers That Be in the Republican Party are fine sacrificing the rights of poor women since their women will always be able to fly to another country to have their “procedures” and probably do a little sightseeing and shopping while they’re at it.
Seanly
@JPL:
It isn’t just about quality of life. Chemotherapy & radiation treatments for many cancers can kill people over 70 faster than the cancer. My wife has ALL but is only in her mid-40’s so there was no question about treating it*. At times, the treatment almost got the better of her and she considered not continuing treatment.
My late grandmother was 93 or so and already suffering dementia and deafness when she was diagnosed with multiple myeloma IIRC. Doctor flat out said that treatment wasn’t an option. The family never told her and she passed away during a nap a few months later.
*My wife is in remission and got an allogenic BMT (now on Day 50), but still has another year of treatment.
Richard Mayhew
@Rob in CT: agreed, there is always a no at some point in the decision, but when one political party.ideology invents shit up and runs with it for five years, it is not a good faith discussion.
Mnemosyne
@Rob in CT:
Honestly, I would rather spend gobs of money on young people than on old people (and I say that as someone who just passed 45). It’s far more cost-effective to add 20 years of life to someone in their teens or 20s than it is to add 5 years of life to someone who’s in their 70s or 80s. Plus, not to be too crass about it, but there’s a much higher probability that a younger person will be able to work and pay taxes to offset some of their treatment costs. Obviously, there’s an emotional component to extending the life of an older person, because no one wants to lose their dad to COPD and cancer at 74 like my family did, but I can’t really argue that extending my dad’s life would have been a better financial bargain than extending the life of a young person with cystic fibrosis.
PhoenixRising
@Seanly: Hey, my wife survived CML. Link to post about some issues related.