In August, Oregon’s Health Evidence Review Commission issued an update to its guidelines for providing cancer treatment to low-income individuals covered by the state Medicaid program. These new guidelines require that Medicaid deny coverage for certain cancer treatments for patients that have been deemed “too” sick, haven’t responded well to previous treatments, or can’t care for themselves.
Through these new rules, Oregon state bureaucrats are severely restricting access to care and dooming potentially thousands of local patients to a premature death.
What’s worse [is] that these new Medicaid guidelines are not grounded in the medical literature or best clinical practices, according to Kenneth Thorpe, chairman of the Partnership to Fight Chronic Disease. Rather, according to Thorpe, they’re based “on the odds of survival observed in a group of patients.” (More)
Here is why it’s so hard for terminally ill patients to get compassion access to unapproved drugs:
Only 6 percent of early-stage cancer drugs ever come to market, because many are found to have severe side effects or simply don’t work. Given those odds, companies hesitate to do anything to jeopardize a product too soon. If they give drugs away, a disastrous side effect or other poor outcome could spur bad publicity and extra scrutiny from regulators. Even more important, if doctors simply let people take untested medicines without going through all the clinical trials, drug companies would most likely never get anyone to enroll in them, never get the data on safety and efficacy for F.D.A. approval and never pass the gateway to big sales. “Even if patients with cancer are willing buyers,” writes George Annas, a Boston University expert on medical law, “drug manufacturers are not willing sellers.” (More)
We now have a White House where the buck never stops. Our post on Edie Sunby described a woman who may lose her life because of the perverse incentives in managed competition. I predict there will be others. The reason? An insurance policy that allows you to go anywhere in the country, consulting with the best doctors at the best institutions is about to become a relic of the past ― at least in the ObamaCare exchanges.
The White House response to this unfortunate incident? Blame insurance company greed. As The Wall Street Journal observed:
Dan Pfeiffer, President Obama’s chief political spinner, sent out a now infamous tweet on Monday linking to a left-wing website that blamed Mrs. Sundby’s policy loss on UnitedHealthcare. The White House default is always to blame the insurers. But UnitedHealthcare only fled the state because ObamaCare’s subsidized exchanges are meant to steal their customers. As more people are pulled into government coverage, policies like Mrs. Sundby’s are harder to sustain economically, so insurers bail.
Mr. Pfeiffer and other liberals suggest that UnitedHealthcare is profiteering, but that’s an odd way to describe a company that has spent $1.2 million on Mrs. Sundby’s cancer care. Liberals also claim the company could have moved Mrs. Sundby’s policy to the Covered California exchange, but the company isn’t participating precisely because the exchange rules are too restrictive. And none of the other insurers that are participating in the state exchange offer a PPO with Mrs. Sundby’s current coverage. Thus she may lose her preferred doctor as well as her insurance.
One patient, in the middle of treatment for lung cancer, said at a hearing before a State House of Representatives committee that she was prohibited from seeing her U.P.M.C. oncologist. Another, with the debilitating autoimmune disease scleroderma, said she was dismissed from the U.P.M.C. Arthritic and Autoimmune Center. A third, a five-year breast cancer survivor who needs follow-up care every six months, was cut off from the doctor who had been with her since she was first given her diagnosis. (More)
As outlined by Thomas Smith and Bruce Hillner in a now-classic piece, too many patients are subjected to punishing and futile treatments. Too much costly imaging is performed, for too little therapeutic benefit. Too often, costly supportive therapies, such as Epogen, that raise red blood cell counts are provided when they are not needed. The lack of easily used electronic health records aggravates fragmentation of care and perpetuates miscommunication and medical errors.
This isn’t an issue of rationing. America can amply afford the $125 billion we devote to cancer care. Cancer accounts for only about 5 percent of our nation’s $2.8 trillion health-care economy. Yet particularly in the case of advanced cancers, both patients and the wider society could receive greater value for what is spent. Many patients require care delivered with greater thoughtfulness: less-toxic treatment regimes that relieve suffering and protect quality of life when curative care is not possible.
Proper care also requires greater clarity and candor upfront — particularly when the prognosis is not what patients are hoping to hear. According to one recent survey of patients with metastatic cancer, “69% of patients with lung cancer and 81% of those with colorectal cancer did not report understanding that chemotherapy was not at all likely to cure their cancer.” False hope provides temporary comfort. It cannot provide the basis for a realistic or humane treatment plan, much less confidence and trust in the providers.
Full piece by Harold Pollack worth reading.
Coping with advanced cancer, Bev Veals was in the hospital for chemo this summer when she got a call that her health plan was shutting down. Then, the substitute insurance she was offered wanted her to pay up to $3,125, on top of premiums.
It sounds like one of those insurance horror stories President Barack Obama told to sell his health overhaul to Congress, but Veals wasn’t in the clutches of a profit-driven company. Instead, she’s covered by Obama’s law — one of about 100,000 people with serious medical issues in a financially troubled government program. (More)