THE UK DEATH PANEL...
Thursday, November 19, 2009 at 08:34AM Socialised medicine is just not inefficient but I contend also evil.
Consider this news.
A drug that can prolong the lives of patients with advanced liver cancer has been rejected for use in the NHS in England, Wales and Northern Ireland. The National Institute for Health and Clinical Excellence (NICE) said the cost of Nexavar - about £3,000 a month - was "simply too high". But Macmillan Cancer Support said the decision was "a scandal". More than 3,000 people are diagnosed with liver cancer every year in the UK and their prognosis is generally poor.
So, in essence, let the liver cancer patients DIE because bureaucrats appointed by Government have deteremined that resources should be allocated in a different way.
This is how the "Death Panel" called N.I.C.E. operates. I sympathise with MacMillan Cancer Support who provide an invaluable service and would say to US readers that this is what awaits you care of Obamacare. When Palins warned of Death Panels all you needed to do was look over here and ask those dying with liver cancer just how good socialised medicine really is. Not spreading the wealth - spreading the misery.
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Reader Comments (48)
The US readers don't have to wait as they've already had the insurance companies' death panels for years (the foxnews fantasy of Obama "death panels" having been a baseless claim anyway). By the way, how many bankruptcies and repossessions were caused by medical bills in the UK last year?
Maybe if some other pharma company could reverse-engineer a cheaper version of the drug then NICE could afford it. That's the capitalist way, don't you know!
So, David, in your system what would the poor bugger with no life insurance do? How does he or she find the £3,000 a month?
That is the problem, Mike. There isn't enough money in the Health Service. The Free Market wouldn't improve it. It would just bring in a Health Service for rich people and just let the poor people die. They made a decision that it is better to use £12,000 to save someones live rather than prolong it by 4 months. I wonder how many of the 3,000 people a year could afford it in a Free Market system and how many insurance companies would pay out on it?
Your post makes no sense. Working within a massive, though finite, budget decisions have to be made w.r.t. priorities.
Are you suggesting any drug/treatment should be funded where it might prolong life for some people?
If so what are the limits of cost that should be met in each patient's case.
If unlimited how do we budget for that and secondly how do we pay for it?
As you don't use "socialised" healthcare which private healthcare provider do you recommend?
What is their stance on life prolonging drugs? Do they use them and if so to what maximum cost?
By the way, how many bankruptcies and repossessions were caused by medical bills in the UK last year?
How do we know? The State hides these costs. What we do know is that many thousands of firms went belly up and many thousands of people lost their homes because of the burdens of tax and cost inflating regulations.
An open, free society would reveal these costs and effects. A total State like ours hides them so it's hard to tell. It's beyond doubt, however, that nothing is as ever destructive to our health and wealth as the State.
I wonder how many of the 3,000 people a year could afford it in a Free Market system ...
Many would be able to afford it. In a free market system the cost of the drug would plummet.
Seamus
Pete's point is right. A free market would bring the price down - supply and demand, y'know?
not twitter,
I make sure I and my family have private healthcare provision. I object in principle to the NHS. I do not agree that "massive" budgets administered by quangocrats is in any way efficient. I think denying the dying comfort is immoral. We all have to become responsible for our own healthcare but Nanny State and socialised healthcare strips us of that dignity.
How do you know the state hides these supposed "costs", Pete? Intuition or prejudice? As for the "free" market, far from bringing costs down, there is a proven correlation between private medical costs and the rate of bankruptcies in the US.
From the "American journal of medicine"...
"Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these
medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for
medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical
bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three
quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable
to medical problems rose by 49.6%. In logistic regression analysis controlling for demographic factors,
the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001.
CONCLUSIONS: Illness and medical bills contribute to a large and increasing share of US bankruptcies."
Stay well, Pete...
'Pete's point is right. A free market would bring the price down - supply and demand, y'know'
Unfortunately there is no free market as the drug companies control the supply. Why does it cost £3,000 per month for a treatment? Surely if the drug company reduced it's price then the drug would be cost effective to supply.
It is clear these drug companies make up a ridiculous price and hope to get the NHS to pay it. You can guarantee that whatever private care you have David would not pay out for this drug as insurance companies are no better than the drug companies when it comes to putting profit before people.
Iron Mike: "Maybe if some other pharma company could reverse-engineer a cheaper version of the drug then NICE could afford it. "
There are a couple of things that need to be said.
You reverse engineer a thing then sell that thing cheaper you are infringing intellectual property, why would the State that says that is wrong for CDs, DVD, and media copywright. Be right for drugs?
If you undercut the innovative companies that produce these things, then within ten years you won't have any innovation in the drug industry. Then NICE won't have any new drugs to wants to ration.
Radio 4 this morning actually used the term 'rationing' in connection with NICE. That was a watershed for the government toadies in the BBC, perhaps they are just preparing for the Cameron administration. You know, that'll be when decisions of NICE will be entirely the fault of the TORIES.
But one of the real reasons why new drugs are so expensive is because of State mandated safety procedures. It is not all big bad pharma, the State has much to do with this state of affairs.
The politiicans want sophisticated drugs
The politicians want cheap drugs
The politicians don't want to be exposed to risk. ( although somebody who is dying might have a very different attitude to risk of new drug side effects than a politician).
Choose any two.
Iron Mike: "That's the capitalist way, don't you know!"
That is certanly a manically deranged portrayal of capatalism.
Seamus: "That is the problem, Mike. There isn't enough money in the Health Service. The Free Market wouldn't improve it. It would just bring in a Health Service for rich people and just let the poor people die. "
Where do you people dream up this shite?
There is plenty of money in the health service, add in welfare and there is 40 - 50 % of GDP being spent in the welfare state.
Much of the millions is being spent of people like this:
http://news.bbc.co.uk/1/hi/england/suffolk/8315400.stm
If some one can explain to me how a man who can barely move under his own volition can even get near the kitchen I would be intrigued to know.
My likely explanation is that hords of social workers swarm over him each day making sure he is comfortable and not in the slightest bit hungry. He certanly isn't earning enough to support his monstorous appetite. This in my opinion is a sort of abuse which should be prosecuted no less rigorusly than child abuse.
It is certanly an abuse of the Tax payer and an abuse of many much more deserving causes.
I think we'd all like to grant as much comfort as possible to the dying. However, in this world everything has a cost. We, or some entity, private or state, has to meet that cost.
My parents are in their 80s. They wouldn't be able to afford private health care nor would they have been able to afford it during their working lives. In a private system they wouldn't get access to treatment they have received in recent years that has prolonged both their lives. At least one of them, if not both wouldn't be here today.
The NHS is imperfect, in some ways inefficient. No doubt. But many people's health and contribution to taxpaying society would be less if we replaced it with a fully private system.
The US is a good example of how near fully private markets can work inefficiently. More per head is spent on medical treatment in the US (than any other country bar one) yet infant mortality and life expectancy are lower than most socialised healthcare systems. If the system were to be, on the whole, more efficient than a socialised system then basic mathematics and standard universally accepted measures used to evidence healthcare delivery should prove that. In the case of the US it does not.
I have a combination of private healthcare and also obviously fund the NHS as all taxpayers do. I don't begrudge my tax contribution to the NHS as it funds and treats people, like my parents, who probably wouldn't receive worthwhile treatment without it.
It's likely that you have relatives or friends in similar positions. In most countries the rich have a choice. In some countries the poor will get very inferior treatment or restricted access to timely treatment. Our country, our system, provides access for rich and poor alike. I can't think of (as an economist) a fairer system.
David when you are honest and admit Death Panels already exist in the US of A then maybe I could take your NHS posts seriously and in the honestly held vein you hold these views. But to hear you play the morality card on healthcare uniquely on this issue is utter hypocrisy.
Michael,
The idea that the Drug companies "make up" product prices is entertaining.
Alison
There is no morality in a quango deciding who lives, who dies. None whatsoever. Do you think NICE is an appropriate organisation and from whence does it get its mandate? There is no morality card being played I am simply observing that those dying from liver cancer deserve better.
Not Twitter
Thanks for your contrbution. Interesting points.
David - do you think an insurance company is an appropriate company to get that mandate? Is it fair that insurance companies can discriminate and do so WAY MORE regularly than NICE? Is that the free markety alternative you want? Because if so I fail to see why you should choose to have an issue with one and not the other. If you want to pull morality into healthcare issues and life or death decisions then you need to examine all systems not just the one. Morality as you would see it comes from the Bible - well I don't recall the Good Samaritan dialling up to check with anyone before helping out or checking the status of supply and demand. It's immoral that rich prosperous societies* cannot manage healthcare efficiently and across the board. Not simply by the standards of those who can best afford it. It's also immoral that drugs/medical companies can charge the earth for market ready drugs and products.
*although France does a pretty good job
Well said Alison.
Iron Mike -
How do you know the state hides these supposed "costs", Pete? Intuition or prejudice?
Common sense, mainly. The State doesn't hide the destruction its taxes and cost inflating rules cause, but it doesn't exactly publicise it either.
For the full explanation, you need to read Bastiat's essay "That Which is Seen, and That Which is Not Seen":
http://bastiat.org/en/twisatwins.html
In a nutshell, what is seen may be the State-created jobs when it diverts taxes into certain sectors ('green jobs' would be an example today). What is not seen is the destruction that has taken place in the free economy when the State seized those taxes. When you suck wealth from a free economy you lower the capital base, lower investment and lower the economic power of everyone. All the State has done is impose burdens on the economy, cause jobs to not be created, or to be lost, while innefficiently diverting capital into sectors and jobs which wouldnt exist otherwise because the demand doesn't exist to cause that investment to happen by free, voluntary exchange.
This destruction is something unseen, but it is no less real for it.
As for the "free" market, far from bringing costs down, there is a proven correlation between private medical costs and the rate of bankruptcies in the US.
What private medical costs? We can lay aside the idea that the US health system is in any way private. On the contrary, it is a government-controlled system with some privately owned firms allowed to operate as long as they obey the great tangle of government rules.
Most of the costs in the system are directly or indirectly attributable to the cost these government rules. There is nothing close to a private system of health care in the US.
There is nothing close to a private system of health care in the US.
Is there a private system of health care anywhere in the world that we could examine to see how it works and how successful it is?
There is no morality card being played I am simply observing that those dying from liver cancer deserve better.
And they can get better. This decision simply means that the NHS will not pay for the drugs, those with liver cancer can buy the treatment privately.
David, if you got your way no one would get their health treatment paid for by the NHS.
Alison
Had the good Samaritan not made prudent financial provision he would have been unable to assist. Margaret Thatcher pointed out good intentions alone are not enough and she is right!
Now - on the subject of insurance, is it wrong to insure against risk? Why is this an issue? Should those who choose not to insure be afforded the same benefits as those who do? Pete's right - the US system is in no way free, I wish it was.
There is also a vast difference between those who take our private insurance and those who have to rely on NICE making the call for them. I don't want a quangocrat telling me what drugs I should have. I might listen to a trusted GP - perhaps - but not a government death panel. You suggest that Insurance companies are operating as de facto death panels, if I understand your argument. I suggest that they operate to provide a service which should be free and unfettered, and that does not happen thanks to the wickedness of government.
Fewsoranges suggests that those dying from liver cancer can still avail from the drug concerned, this just have to pay the current rate. But that rate is inflated by government, plus those same people have been sold the lie of universal health care, so they are double losers. That's unfair.
Ultimately, our health is our concern and we must all prioritise as best we can. I know that the French model seems better than the UK and maybe there are learnings there. But in the UK, the NHS is the worst of all worlds - not fit for service in 2009.
It's also immoral that drugs/medical companies can charge the earth for market ready drugs and products.
Best do away with all those laws which protect drug companies then, get some competition going.
If a flash TV had cost £3000 a couple of years ago, where do you expect the price to be now - higher or lower than that?
Lower? Correct.
That's free(ish) market competition for you. So why can't it happen with drugs? Because they've bought up enough politicians to protect their products from free market competition, that's why.
Less government is required, not more.
Best do away with all those laws which protect drug companies then, get some competition going.
Including all patent laws?
Y'all forget that the good Samaritan pulled money out of his own pocket to pay for the man's care, although David alluded to it! We have to ask ourselves why thease drugs cost so much. Sure there's research, but the drug companies do make a "killing">
Charles
High margins but high R&D costs. Plus the investors like the returns!!
David you say 'The idea that the Drug companies "make up" product prices is entertaining.'
How many drug companies have been fined for operating cartels even after they spend a fortune lobbying and bribing doctors and politicians?
This is not about product protection but multi national drug companies making huge profits off the backs of ordinary people whether we pay towards the NHS or private insurance.
For the first time ever I actually think I agree with Pete Moore!
Iron Mike, I am somewhat ashamed to admit the much of my present financial problem can be traced to medical bills. Dental is really not covered here. $1000 max a year. But when the trouble n'strife needs $20,000 or more in work, what does one do? He pays, and he owes, he owes, and off to wok he goes!
David, true, without high return on investment, the drug companies won't commit the billions needed in reseach. But then we go wobbly in having the dying pay those bills.
We put so much money into the last year of life in our countries. Our "do whatever it takes for Ma" attitude is natural, but one must wonder if it's the right thing to do. Keeping the dying alive 6 months longer is VERY expensive. I don't think society, or even the Church, would say this is a collective obligation. The dying must be kept comfortable, but extraordinary measures are above and beyond.
Charles -
Good to see you.
We have to ask ourselves why thease drugs cost so much.
The former research scientist Dr Mary Ruwart has done that:
http://www.campaignforliberty.com/article.php?view=368
Her view is that one law alone in the US is primarily responsible - the Kefauver Harris Amendment of 1962. In her view drugs would cost 80% less than they do now without it and take 5 years to come to the market instead of 15 on average.
And Pete, that Amendment was brought in because Thalidomide, when Drug Companies released a drug to cure morning sickness in women without testing it properly and found out afterwards that it caused sever abnormalities in unborn children.
Seamus -
A typical government measure then - always fighting the last crises.
Fews Orange -
I'm coming round to the idea that patent protection should go. I can only see it doing more harm than good, including to profit levels. It's bad for innovation, productivity, free markets and the consumer.
Her view is that one law alone in the US is primarily responsible - the Kefauver Harris Amendment of 1962.
And what is the evil that the Kefauver Harris Amendment insisted on.
Kefauver Harris Amendment
The bill by U.S. Senator Estes Kefauver, of Tennessee, and U.S. Representative Oren Harris, of Arkansas, required drug manufacturers to provide proof of the effectiveness and safety of their drugs before approval.
Thanks Pete. As a Pharmacist, I have seen $500 tubes of creme. Should any tube of creme cost $500? And of course nobody buys it unless insurance picks it up. And then there's Solodyn, a long acting minocycline prep that costs $500. Now the minocycline in it is a common drug, and the whole bottle might cost $1 to produce. It's sole existance is to help the drug companiy screw the insurance companies. And it's for acne!
$500 for a tube of spot remover that probably doesn't work.
Drug companies always mark up their prices. Its part of the Capitalist way. Most people would rather get shafted by the drug companies than die or be really ill.
I imagine most of you Free Market liberals would be against price controls?
$500 quid for an acne cream. Hmmm, doesn't sound like an open, free and vigorous market for that product. Would the government be anywhere near that sector?
I imagine most of you Free Market liberals would be against price controls?
Anyone with a brain cell would be against price controls.
So your not against them Pete?
Only joking.
If Drug Companies don't offer fair prices for their drugs then the Government needs to step in and lower them.
It certainly didn’t cost the Good Samaritan hundreds of thousands to be able to afford to help else he would have thought twice. You don’t see all the ‘crats David. That’s the heart of my issue with your approach to this debate. Yes its imperfect. But then if we shone a torchlight into enough US cases no doubt that would raise a few eyebrows. The opinion you hold of the NHS is yours. Its certainly not mine or my experience and God knows I have needed to rely on it at some vital times. When I’ve done so I walk away reassured that I won’t be paying off vast vast sums of money for the rest of my life or waiting for an insurance man to say no to the most basic treatments. It also leaves me enough to top up privately. As I see fit.
Seamus -
No, the government need do no such thing unless it wants to bankrupt the industry.
What it wants to do is sweep away all those laws which inflate the cost of drugs and restrict competition by raising costs to new players. It won't do that because too many politicians are paid by drug companies to keep the competition away. Artificially lowering prices will sweep away supply and leave shelves bare.
You may not be interest in the cast iron laws of economics, but they are certainly interested in you.
Pete there are no cast iron laws of economics. Hence the fact that Economists can't agree on them. They can't agree on what needs to be done. They can agree that if you do x then you get y. There are many different arguments. There are no facts only thesis. Just because you believe in Friedmanite Economists does not mean that his hypotheisis is cast iron fact. The fact of the matter than the longest sustained period of economic growth came at a time when the Government had a direct say in the Economy, including Price Controls.
What it wants to do is sweep away all those laws which inflate the cost of drugs and restrict competition by raising costs to new players.
What company is going to spend money developing a new drug if as soon as it hits the market someone else can manufacture it with no development costs?
Seamus -
All economists agree on certain fundamentals, that trade increases prosperity for instance. Even Keynesian pretendy economists such as Krugman recognise that.
Arguing over where exactly interest rates will be in five years time is someone else entirely. That's not economics, that's guessing. And I'm not a Friedmanite.
FewsOrange -
What company is going to spend more on developing new cars? What band will devote time and energy to making new records? You can apply that drug patent argument to just about every other industry and find it doesn't apply.
If you want to keep your property to yourself, keep it to yourself. It is a bit rich to develop a product for market, market it, distribute it, get it into as many homes as possible but then claim oh no, that's our property.
There are studies which turn the IP logic on its head. Many industries seem to have found increased prosperity without the protection.
What company is going to spend more on developing new cars? What band will devote time and energy to making new records? You can apply that drug patent argument to just about every other industry and find it doesn't apply.
Of course it applies. If Elvis Costello records a new album I can't legally copy it and manufacture my own CDs and sell them.
If BMW come out with a new model I can't legally copy it and sell the copies.
When Karl Benz invented the motor car, he didn't have a State-imposed protection against anyone else making their own cars.
If BMW invents a device, say, to capture and store braking energy, the competition are free to take it up.
When Karl Benz invented the motor car, he didn't have a State-imposed protection against anyone else making their own cars.
And there is no State-imposed protection against anyone else making their own drugs. However there is a State-imposed protection against anyone else making the same drug, just as there is a State-imposed protection against anyone else making the same car.
APL, reverse engineering worked well For Compaq when they did just that with the "IBM PC" and proceeded to wipe the floor with them. Tenuous though it was, I used the reverse-engineering example to hint at the extreme, maybe illegal, lengths a new company would have to go to compete in the corporate lockdown that is "big pharma". And as for innovation, they only "innovate" new ways to screw the customers because they control the market.
Would you rather get rid of "state mandated safety procedures" and have cheaper, hazardous drugs?
The fact that NICE withheld treatment has more to do with budgetary inefficiency ( lets not forget PPPs and PFIs) along with too much bureaucracy/managers than it is to do with the greed of pharma as it exists.
"That is certanly a manically deranged portrayal of capatalism."
No, APL, that was sarcasm. You'll know for next time, 'kay.
Pete, as my data showed, private medical costs were high enough to bankrupt fully insured middle-class people who became seriously ill. Does that sound like good value for money? These people were also the most likely to be denied either new treatments or standard procedures because of the old "pre-existing condition" loophole.
Bastiats essay shows some well thought out opinion but I think some concrete data showing the relationship between UK "socialized medicine" costs and personal bankruptcies/homelessness would be better, don't you.
NICE withholding treatment is wrong. Private healthcare (US stylee) withholding treatment and bankrupting you as well is evil...
Hiya Charlie in Texas. Sorry to hear about your situation. You shouldn't be ashamed though because the extortionate amounts you pay for treatments aren't your fault. I do understand how you feel because I have a brother in the US who has had leukaemia for about a year and a half His job wasn't kept open for him and they now depend on his wife's earnings and the insurance won't last much longer. You can tell in the emails I get from them that they are very anxious as to how things are going to pan out. To make seriously ill people live under such fear and uncertainty is truly evil, in my opinion...
Thanks Iron Mike, and my prayers go out to your brother and his family. When I was out of work for 2 months, I realized what it was like to have fewer and fewer options. The noose can really start to tighten. You have no money and no where to turn. I actually almost pawned my wedding ring for groceries. My own damned fault and I've learned my lesson.
But your brother is in trouble through no fault of his own. He's gonna run through every penny he has, then goes the house. I hope it doesn't get to that. It's funny, but sometimes you can realy find strength through adversity. I hope he digs deep and finds it, and asks for the Lord's help as well.