The question of cost in treatment

July 16, 2008 21:10 by Lisey

I was just reading that two major medical associations are trying to help their oncologists be able to discuss treatment costs with patients.  For the first time ever, cost is being evaluated in cancer treatments along with effectiveness.  Some socialized medical proponents are up in arms because they feel when you bring the patient's treatment expense into the picture, poor people won't get or pick the best treatment. 

Co-pays are a huge portion of expense in cancer treatments, both with Medicare, Medicaid and private Insurance.  As a patient, would I like to know how much such and such treatment is going to be versus another?  For me, I think I would want to know and it may affect my decision - just what the socialized crowd is against.   If X treatment was 45% effective and cost $3K a month in copays and Y treatment was 40% effective and cost $1K a month, I'd pick Y.  (and No, I don't think 'society - aka people's taxes' should have to pay the difference in the drugs for me.) It is my right to know expense and perhaps if everyone did, X would have to lower it's cost to even have any business at all.  I don't agree that we as a society should shoulder the burden of saving every life no matter the cost.  Cost / Benefit analysis is the basis of important decisions.  Some say that if Oncologists bring up expenses with welfare patients - then they will have conflicting duties (to minimize expenses for society vs. best possible care for patient).  Well, that may be so, but doesn't the patient deserve to know?

So maybe people wouldn't pick the 'best' drug out there if they knew the cost - I believe that market competition would kick in and at some point the 'best' drug out there will become cheaper both for society and the individual.  I'm tired of people trying to 'protect' others from all the facts and knowledge.  I welcome bringing cost into treatment discussions.  Let the people decide and the markets will follow.  Just because one pharmaceutical says their drug is $200 a pill, doesn't mean it will stay that high if no one buys it. One last thought... if money suddenly had a place at the table in discussing options, perhaps overlooked and cheap alternatives can be brought out.  My dad was mentioning that some type of Tea has the same benefits as an expense heart medicine but because it is 'unpatentable' no one brings it up to patients.


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July 17. 2008 03:56

Cyn

Very interesting post. I would just like to ask Lisey: if your little feisty one was in desperate need of a drug and you couldn't afford it, would your answer still be the same? Or would you do anything it took to get that little guy the drug?

I know that it's easy to be very cut and dry when it comes to medical treatments for others....but when it hits home, it becomes less cut and dry.

I myself would choose hospice under almost all conditions, refusing all extraordinary treatment. I have a "thing" about artificially postponing my life when the quality of that life would be poor (chemo and radiation kill almost as many as the cancers themselves--and the pain and suffering is more). However, to make such a decision for another person is mpossible for me....and if it entails little ones, I become wild and erratic in order to get whatever it takes. I'm certain others would feel the same.

As my generation, the Boomers, hit old age, this question is going to take front center stage because we will bankrupt our children and grandchildren's generations if we insist on advanced medical care.

Cyn

July 17. 2008 14:01

Lisey

Every day, cost factors into decisions regarding my Children. I don't buy organic (because it costs more) even though I may be giving my kids pesticides, hormones and carcinogens. I let my kids talk on the cell phone *brain cancer* to their Grandma because I'm too cheap to have long distance on my home phone.

Would I pay $2000 more a month to increase a survival rate by 5%? It depends on who else that $2000 is supporting. I do not think any person can demand a society pay for their child/self/parent's care to the highest cost. If it is a difference of 50% cure rate, that's one thing - but most times the most expensive option is minimally more effective. It reminds me of the extraordinary measures for preemies under a pound. Parents demand it, yet the costs are so high and the outcomes so grave... it's an irrational demand and others shouldn't be forced to do it.

This leads to the idea that the wealthy can do things others cannot. Well... that's true for everything. They eat organic chef meals that are much healthier than my McDonalds. They can travel to China and get alternative stem cell therapy. They can do anything in their desperation to try and save a life. Does that mean everyone should expect that? My answer, including myself and family is no. Only what I can afford or raise on my own without 'forcing' others to support me.

Lisey

July 18. 2008 10:39

Firebyrd

Of course, this also brings up the whole issue that if we're depending on society to pay for things, a lot of the times, they don't. I don't know what would specifically happen with welfare patients, but the elderly and the very young (pre-mature babies, specifically) stop getting treatment with socialized healthcare. I really don't know where to place the ethics of such things (it probably needs to be determined on an individual basis), but I resent any system that would automatically refuse to treat someone based on age. Here in the U.S., we obviously do go too far to some extent, but on the other hand, it seems like automatically letting anyone die with X condition (or under a certain prenatal age in the case of preemies) without taking all factors into consideration seems wrong too.

And now I'm just babbling, but cost is a very real factor that does need to be considered while at the same time maximizing benefits for those who choose to receive them (and are paying for them, whether through insurance premiums or whatever).

Firebyrd

July 20. 2008 05:56

MoJo

As my generation, the Boomers, hit old age, this question is going to take front center stage because we will bankrupt our children and grandchildren's generations if we insist on advanced medical care.

Yes, you will. I work in a margin of the healthcare industry and I can't tell you how many times I've been involved with 90-year-olds who want, ask for, DEMAND triple bypass surgeries. At some point, the treatment becomes counterproductive to society's needs.

First, Medicare is paying. That costs me money.

Second, Social Security is paying. That costs me money.

So we're paying FOR these people to stay alive and then paying them TO stay alive. Maddening, really.

...if your little feisty one was in desperate need of a drug and you couldn't afford it, would your answer still be the same? Or would you do anything it took to get that little guy the drug?

There are other variables that need to be considered. What is his chance of surviving?

I personally am more concerned about the treatment being worse than the disease, worse than death. Would I let my little one go? Depends on the odds of his survival and quality of life and how much of a sacrifice it would be to the rest of the family for how long. I can say that I would let him go in some cases, yes.

On the other hand, I can only say that because I have an absolute faith in how we LDS see the afterlife.

MoJo

July 21. 2008 03:50

Lisey

It may sound morbid, but I agree that we have to decide when to 'cut services' that prolong life. There was a huge debate in England when they said they would not help 25 week old preemies because the costs (not just financial) were so great. Should it be case by case? You open doors of litigation and 'appeal' which keeps the fetus living until all appeals are exhausted. As technology gets more and more capable and odd... we expect that all should be entitled to it. I totally disagree. Just because you can do it, doesn't mean you should.

In the end, people are terrified of death. They are desperate and want 'anything that might prolong life.' I think it's a bad attitude. I like the Buddhist belief on death and we shouldn't run from it. If you want to tap out your savings or find a willing benefactor(and deal with those consequences) cheating death - that is up to you. But to try and force me (society) to fund your race against time, well... that's the big issue.

Lisey

July 21. 2008 04:20

Cyn

Very interesting comments. I think people need to get back to nature....one hundred years ago, death was part of living--and people lived until the very end because diagnosis wasn't possible for most. They then went quickly, but with pain. Today, I would like to get back to living as long as possible--naturally--and then going to hospice for pain control. I do not want to torture my body with chemo or radiation (unless both are significantly improved and create less damage to healthy systems). I really want to exercise, eat better, and enjoy life...and then when it's time to go, just to go.

As a believing LDS woman, I believe stewardship of the body is sacred but death is also sacred. I don't want to fight it like some I know have. If a cure is relatively simple, I'll go for it, but otherwise, no.

Cyn

July 21. 2008 05:43

MoJo

I think people need to get back to nature....one hundred years ago, death was part of living--and people lived until the very end because diagnosis wasn't possible for most. They then went quickly, but with pain. Today, I would like to get back to living as long as possible--naturally--and then going to hospice for pain control.

I completely agree with this. See, I think the way we go to extremes prolonging of life (as an elderly person or in the NICU) is as detrimental as elective (note I said ELECTIVE) abortion. I have no idea what is up with this relatively recent "life at all costs" business.

MoJo

July 21. 2008 05:49

Fidel

You Americans make me laugh--Ha Ha Ha--you spend more money per capita on your medical care than any other country on Earth yet you are some of the least medically served developed people living on the planet...as well as losing your status as a developed country in all other areas too!

http://news.bbc.co.uk/2/hi/americas/7511426.stm

You Mormons also make me laugh! "By their fruits you shall know them" you quote from your scriptures, which if true means your country must be a poison tree. The same poison tree your ancestors tried to escape from by running off to what was at the time Mexico...

Your American doctors have the "freedom" to not treat a little child already in hospital with a severe broken leg just because that child doesn't have the right (the elite) medical insurance!

www.salon.com/.../index.html?source=newsletter

Such freedom! The freedom to violate the Hippocratic Oath and still expect to make money as a doctor...

I light a cigar to you!

The hypocrisy of your country is just so typically American awesome. You are a train wreck which makes the rest of the world sick just to watch happen... And, scary too, since we are only ninety miles from your awesomely "free" shores!

Fidel

July 21. 2008 06:10

Cyn

Fidel, I see that you have the same "icon distributor" as I do! Mine looks like a discombobulated poopy and yours looks like a right-brained potato!

As any proponent of free will MUST maintain, one individual has NO right to the intellectual knowledge of another, and that includes doctors. To force the human mind is to enter a Satanic Faustian drama. God won't do it....so why should you?

Cyn

July 21. 2008 08:00

Lisey

Fidel, I read the article on the kid with the broken leg. Here's my opinion on it. The author claims we need to remove restrictions from international pharmaceuticals offering cheaper pills. First off, billions have been spent by our US pharms to create, test, and release meds. Knock offs are made that violate patent laws. It is foolish to think that it's ok to allow patent violations for the sake of the poor. Why would a company invest billions if their invention can be 'stolen' by others and sold by some other company? Do you think cancer drugs would be created? NO.

Also, this author thinks 'everyone' should have access to superior care. Well, who decides what 'superior care' is? Is it the expensive and highly unproven stem cell injections? Is it Hyperbaric chambers to treat stroke at $600 a session? A lot of people throw their money at new treatments in desperation. Are we as a society REQUIRED/ FORCED to treat welfare/medicaid patents with that same desperation? It bothers me to no end that some, such as yourself, would suggest whatever someone wants medically - they are ENTITLED to recieve from the force of others to pay for it.

Lisey

July 21. 2008 09:29

Fidel

Dear Poopy & Bothered No End,

The joke is on you!

http://www.msnbc.msn.com/id/25354060/

Viva La Revolucion

Sincerely,

Fidel

July 22. 2008 02:56

Cyn

Fidel:

In Cuba (which by the way has one of the lowest life spans in the Americas), they tout 5 months extra survival. This is exactly the wrong thing to say to those of us who believe in freedom from governmental force....five months of uncertain life quality as opposed to thousands upon thousands of people who are forced to contribute even though their standard of living is poor and their children have little education. Give me a break!

As for your revolution, I see the same old, same old. A few men getting supreme power over the many...who have little or no influence on government. Now you could say that the oligargy running America at this time is just the same....but you'd be wrong. The Bill of Rights exists here--and has SOME meaning still--but it does not exist in your revolutionized Cuba.

And to paraphrase the intrepid police detective in "Airplane":
"Don't call me Poopy!"

Cyn

July 22. 2008 02:57

Cyn

OOPS! Spelling error in the above post! "OLIGARCHY"! Sorry!

Cyn

July 22. 2008 06:52

Fidel

Unfortunately, Cyn, it ain't necessarily so!

Our lifespan in Cuba is almost the same as the United States and we have been living under a severe economic and medical blockade by your country for over a generation as no other country has suffered in the world! Yet we almost match you in lifespan and are superior to you in other objective social goals, such as education...

http://www.inteldaily.com/?c=145&a=1912

Besides in some provinces our Cuba lifespans are superior to those in the Capitalist United States who have to rely upon Viagra when older and still keel over with thrombosis in coitus, but this is due to us smoking lots of Cuban cigars and having much exercise sex (as Ayn Rand promoted).

http://news.bbc.co.uk/2/hi/americas/5407636.stm

So, You, funny funny Americans, you know so much that isn't so! Those smirks on your proud but ignorant faces need to be plugged with a big Havana hand-rolled one!

It's medicinal.

Fidel

August 25. 2008 13:22

TQ

Fidel,

Thanks for the inteldaily link - it was HILARIOUS.

Is it really 638 attempts on El Presidente's life? Is that a firm total, or is it "and counting"?

Instead of Castro, we should call him Clouseau.

TQ

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