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.