Health Care Rationing

[Pexster]

Did you see the 60 Minutes story on The Cost of Dying? Last year, Medicare paid $50 billion for the cost of caring for people in the last two months of their lives.

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By law, Medicare cannot reject any treatment based upon cost. It will pay $55,000 for patients with advanced breast cancer to receive the chemotherapy drug Avastin, even though it extends life only an average of a month and a half; it will pay $40,000 for a 93-year-old man with terminal cancer to get a surgically implanted defibrillator if he happens to have heart problems too.

Why can't we, as a society, discuss this rationally? Why do we have people talking about "pulling the plug on Grandma?" If Grandma and her family are rich, they can spend however much they want for whatever they want. But a rational society should make rational policy decisions about its collective health care budget.

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"I think you cannot make these decisions on a case-by-case basis," Byock said. "It would be much easier for us to say 'We simply do not put defibrillators into people in this condition.' Meaning your age, your functional status, the ability to make full benefit of the defibrillator. Now that's going to outrage a lot of people."

"But you think that should happen?" Kroft asked.

"I think at some point it has to happen," Byock said.

"Well, this is a version then of pulling Grandma off the machine?" Kroft asked.

"You know, I have to say, I think that's offensive. I spend my life in the service of affirming life. I really do. To say we're gonna pull Grandma off the machine by not offering her liver transplant or her fourth cardiac bypass surgery or something is really just scurrilous. And it's certainly scurrilous when we have 46 million Americans who are uninsured," Byock said.

[brandon184]

Quote:

Originally Posted by Pexster

Why can't we, as a society, discuss this rationally? Why do we have people talking about "pulling the plug on Grandma?"

Because no one is interested in discussing how much we're really willing to spend on someone's life, and how much extending someone's life by a month is worth in terms of dollars. To the families and friends of dying patients, extending someone's life for a month may be invaluable.

I think that if you're paying $55,000 for a drug, the question isn't, "Should we just let people die instead of spending this money?", it's "Why do we have to spend this much money for our drugs?"

Maybe we need to have rational discussions about our pharmaceutical industries and figure out how to develop, produce and deliver drugs that don't cost an arm and a leg. Maybe we need to look at whether drug company profits are healthy or obscene.

Avastin costs $50,000USD in the U.S.? It costs ~$35,000USD in the Canadian province I live in. Why?

Brandon

[The Real Bingo]

Quote:

Originally Posted by brandon184

Maybe we need to have rational discussions about our pharmaceutical industries and figure out how to develop, produce and deliver drugs that don't cost an arm and a leg. Maybe we need to look at whether drug company profits are healthy or obscene.

I ask you to look at profit margins at tell me what is too much. What is obscene? You know nothing about the drug business. I know nearly nothing, but I do know that for every drug that 'works out' there are dozens that do not. Those are waste - waste in terms of money, time, and resources. Drugs take years and a whole lot of money to develop. There is a lot of risk and a lot of resources being tied up. So the successful drugs have to be profitable to recoup the losses for the failed drugs. Drug companies are in a high risk business and as such should make a good return on their sales...otherwise, why take the risk? I'm sure you're familiar with risk and reward, right?


Regarding the question...we can't have a rational discussion because 'putting down' a human is blasphemous. No one wants to talk about it for some reason. We can relieve our pets of pain by putting them down, but when it comes to human suffering, we seem to want our loved ones to hang on as long as possible, without regard to what they are feeling (of course this is assuming they are not 'all there').

More people should have living wills specifying how they want to be treated. The day will come for most people, unless you're lucky enough do die in you sleep.

The one entity that should have nothing to do with this is the government...and that's what I fear is coming to our shores.

[Vagabond]

Does anyone here even know how much a clinical trial up to proof of concept costs? That would be Phase I to Phase 2. This does not even count the amount of money it costs to even come up with a possible drug that works in a mouse. Now these numbers flux depending on the type of disease one is trying to treat. To take compound that has worked in mice and has passed initial safety studies of with can cost up to and well over $2 million. Now starts the clinical trials. For a small Phase 1 study consisting of say 6 doses (dose escalation study for safety - single dose study mind you). Costs at a min of 1.5 million. Ok great you show that the drug did not hurt anyone. Now on to Phase 2 studies (that is assuming the drug does not have to be tested in multiple doses, this would double your phase 1 costs). Phase 2 is actually looking for some efficacy. BTW over 70% of all drugs fail in Phase 2 (all that money is lost). Also, remember that patent life on the compound is already ticking away and probably has been for at least 3 years if not longer (19 max). Ok now on to the big numbers the Phase 3 trials. For our compound we will say it looks really safe and some hints of effect at Phase 2. So we only need a small ~8-10 million Phase 3 trial. These numbers do not even reflect the cost of manufacturing the compound for trails which can be well over 15-20 million, depending on the type of compound. So at a minimum to bring a successful drug to market it costs a company well over $30 million (and this is a low ball number btw, have seen them go well over 50 just for Phase 3) just to file a new drug and the company has to make enough to support the other 80% of failed phase 2 trials, pay all of their employees so they can make new attempts at producing a new drug and they have to do this in around 12 years or so (when patent life runs out).

[Pexster]

We can discuss not providing expensive drugs and surgeries just to gain a few more weeks of life without calling it "putting down" humans. How about just letting people who are going to die, die?

As for drug costs, no one addressed Brandon's question of the price differential.

[MTAtech]

I don't know much about the drug business either but I have eyes. I see the drug business place expensive ads on TV promoting their drugs. I also see the salespeople waiting to see my doctor and I see the free samples that my doctor friends and relatives get.

I suspect that marketing expenditures by drug companies far outweighs R&D costs.

[pickel]

When I get to where I can't get out and fool around with or drive my cars and have to be confined or have some bitch of a nurse to take care of me, I'd just as soon get a couple of hits of whatever and have then take to the fire. I want my ashes to be in good company in the Atlantic deep with those who bit the bullet and meet their fate defending our Country.

[Cmptr-Gy-Dv]

Quote:

Originally Posted by Pexster

Did you see the 60 Minutes story on The Cost of Dying? Last year, Medicare paid $50 billion for the cost of caring for people in the last two months of their lives. Why can't we, as a society, discuss this rationally? Why do we have people talking about "pulling the plug on Grandma?" If Grandma and her family are rich, they can spend however much they want for whatever they want. But a rational society should make rational policy decisions about its collective health care budget.It's not as if we don't have rationing now.Rational comments?

and your what 55 so why don't we just bump you off now and save the money for the ambulance ride later, see I like this you saved me money already, hell why don't we just start internal wars ya like a civil war thats it, hell knock down the population and insurance goes down, or stop the war on drugs hey let the crack heads die,

you see how we end up when we think we own somebody else's life, and think they have become a burden to our growth,

[cksboy15]

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you see how we end up when we think we own somebody else's life, and think they have become a burden to our growth,

This is why I think living wills should be mandatory. Course I also think medicare and social security is failing considerably and either needs to be changed. Course those programs were designed when the life expectancy wasn't as high as it is today.

[tony_j15]

Quote:

Originally Posted by Cmptr-Gy-Dv

and your what 55 so why don't we just bump you off now and save the money for the ambulance ride later, see I like this you saved me money already, hell why don't we just start internal wars ya like a civil war thats it, hell knock down the population and insurance goes down, or stop the war on drugs hey let the crack heads die,

you see how we end up when we think we own somebody else's life, and think they have become a burden to our growth,

well, the discussion was reasonably rationable up to this point

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This is why I think living wills should be mandatory. Course I also think medicare and social security is failing considerably and either needs to be changed. Course those programs were designed when the life expectancy wasn't as high as it is today.