Turns out, that's the value of a human life NOW, under current Medicare rules. However:
"In theory, a year of human life is priceless. In reality, it's worth $50,000."
"Zenios's conclusions arrive amidst mounting debate over whether Medicare, the U.S. government health plan for seniors, ought to use cost-effectiveness analysis in determining coverage of procedures. Nearly all other industrial nations — including Canada, Britain and the Netherlands — ration health care based on cost-effectiveness and the $50,000 threshold. . . Such a move would mean that "if the incremental cost of a new technology was more than the threshold," Zenios says, "then the recommendation would be that Medicare not cover that new technology."
If it costs more than 50k, then you don't need it. The government says so. THIS is 'universal healthcare'. England goes ONE step further. If the government says no, and you do it anyway, then the gov't revokes your health care because it's 'unfair' for you to go beyond what the average person gets. And now comes new considerations for no longer covering smokers and the obese.
How much is a year of healthy living worth to you? Priceless? Well, that's your opinion.
"A ban on smokers and the obese getting certain NHS treatments in some parts of the country was defended by Health Secretary Patricia Hewitt today.
She said it was "perfectly legitimate" for primary care trusts (PCTs) to set a collective policy to deny operations to certain patients.
Ms Hewitt was responding to a Sky News survey which found nine PCTs refused joint replacements to obese patients and four blocked orthopaedic surgery for smokers. "
"A WOMAN will be denied free National Health Service treatment for breast cancer if she seeks to improve her chances by paying privately for an additional drug.
Colette Mills, a former nurse, has been told that if she attempts to top up her treatment privately, she will have to foot the entire £10,000 bill for her drugs and care. The bizarre threat stems from the refusal by the government to let patients pay for additional drugs that are not prescribed on the NHS.
Ministers say it is unfair on patients who cannot afford such top-up drugs and that it will create a two-tier NHS. It is thought thousands of patients suffer as a result of the policy."
~faith,
Timothy.
The difference here is that the drug is not available on prescription on the NHS. There are also a few issues on what is called Postcode lottery where some PCT will fund treatment and others wont, the government is supposed to be stamping that out. But if drugs are not on the prescription list then GP's can not prescribe unless a private prescription which does cost a lot more than NHS.
ZASHAGALKA let us accept your premise that private insurance will ,if it controls the whole populations access to healthcare , creat insurance products to cover all risks , the premiums would be related to the risks the individual presents when they apply for insurance .
When the client with a pre-existing , chronic condition receives multiple quotes ,none of which they can afford , what then?. Do we as in the case of car insurance , then accept that we are going to have a large number of uninsured , or do we the paying clients of the insurance companies ,then have to pay out for the uninsured to be covered ( which is what we are doing at present , through our tax dollars, subsidizing the private industry ). In answering this question remember that you are advocating private healthcare for all , so do not throw these clients under the wheel of the bus , rather enlightene us as to how an unfettered private system would cover all .
As to government lobbyist , I thought lobbyist were those who represent the insurance industry .
Once we get prices controlled by returning to the only proven way to do so, market exchange of services, then, AND ONLY THEN, it makes sense to subsidize those that need help.
The first priority is to place the price of care within reach of most. INSURANCE can do that in a way what we call insurance today, pre-paid health care, cannot.
Typical of government, the gov't uses subsidies to employers, EMTALA, and other means to jack of the price of insurance and health care generally, and then pays its own premium on the back end. The result: Medicare is going to go bankrupt in 2019.
Not somewhere down the road. Within most of our working careers. How are we going to implement a 'universal coverage' when we can't afford what we provide, now?
How? That's simple. Ration care.
This is easy. It's simple economics. Supply must balance demand. When you create unlimited demand (IT'S FREE!!!!), then you must either create unlimited supply (impossible because too much of health care is essentially human resources) OR, you must artificially curtail supply. How you curtail supply is to ration care.
How you limit supply is to get lobbyists together with politicians to decide that 100 people here, or there, should be allowed to die. He who pays, decides. Gov't health care is restricted care because the primary goal of such care isn't univerality. No. It's designed to remove choice from YOU and put it in the hands of lobbyists.
Rail against private insurance all you like. Gov't restricted health care will be little more than Haliburton, in charge of your health.
The difference here is that the drug is not available on prescription on the NHS. There are also a few issues on what is called Postcode lottery where some PCT will fund treatment and others wont, the government is supposed to be stamping that out. But if drugs are not on the prescription list then GP's can not prescribe unless a private prescription which does cost a lot more than NHS.
But that's the WHOLE ISSUE. The whole point of 'cost effective analysis' is to decide how many people it is acceptable to have die rather than use resources on this treatment, or that.
THIS was my point. Treatments not provided by the government cannot be allowed to be purchased separately because it wouldn't be fair.
Equity is more important than any individual life. Or, as the study I cited showed, hundreds of lives.
That kind of 'fairness' isn't very fair if it is YOUR death sentence being decided, "in your best interest." Just ask Colette Mills.
Specializes in Medical and general practice now LTC.
In some ways I can see your point Timothy but having lived in the UK and seen how things are played a lot is in my opinion political and dependant on whether the areas are deprived or not. It is documented that deprived areas have different issues and the local primary care trusts have to decide on how to spend their budget accordingly. No it isn't fair but also is it fair on drug companies and companies selling equipment to charge lots of money when they have the monopoly on patent or know they can charge what they want?
In some ways I can see your point Timothy but having lived in the UK and seen how things are played a lot is in my opinion political and dependant on whether the areas are deprived or not. It is documented that deprived areas have different issues and the local primary care trusts have to decide on how to spend their budget accordingly. No it isn't fair but also is it fair on drug companies and companies selling equipment to charge lots of money when they have the monopoly on patent or know they can charge what they want?
Long post, I'm not doing "talking points" here:
I think it IS fair for drug producers to have a season of patent protection and to "charge what they want". I agree, so long as YOU aren't paying the bill, that amount really CAN be astronomical.
If YOU are paying the bill? The market can only charge what the market will bear. Free trade is win-win. The seller gets what HE wants and the buyer gets what HE wants. Trades do not occur unless both are the case. When you introduce a middle man, you skew that win-win result.
Look. CT scans would NOT cost 1,000 if YOU had to pay for it. The electricity to run the scan is pennies. The real time investment in machinery is offset by the number of scans run: the more scans run, the cheaper that investment. Doing a scan and reading a scan takes all of 5 minutes and another 10 minutes for somebody to transcribe. Machine, electricity, scanner, doctor, transcriptions - final report = 10 minutes of work. Could be done, in a "volume volume volume" way, for well under a hundred bucks. Probably less than $50. It costs a grand for one very simple reason: YOU DON'T PAY FOR IT.
In the UK, it's FREE but budget constraints mean there simply aren't enough machines, doctors, scanners, or transcriptionists. So, how good is "free"? It's great, if, big if, IF YOU CAN GET IT in a timely fashion.
In America, it's rationed a different way, by cost. It's not free; it's a grand to do a CT scan. But, that price is inflated. It's inflated by the fact that it's paid for by a third party. The actual recipient of the scan cares little about the costs as they will not pay for it. It's a great system if, big if here, IF YOU CAN AFFORD THE THIRD PARTY PAYOR (Insurance).
There's a problem with both methods of rationing. The current system isn't a cure for gov't controlled care, or vice versa. Both institute a very high level of rationing. Either method will just transfer the method of rationing from pricing to wait lists to reduce coverage or some combination of all.
Going back to your drug statement. I believe in patents. I believe in profit. I believe that Tylenol should cost $70/pill - if, and this is a big if - IF THEY CAN GET SOMEBODY TO PAY THAT MUCH.
I believe that I am worth $5,267/hr. And, I am, if, big if, IF I CAN GET SOMEBODY TO PAY ME THAT MUCH. This is how the free market works.
Those big time drug companies get to charge so much because, big because here, BECAUSE SOMEBODY WILL PAY FOR IT. And, since it's not you, the final consumer, who cares what it costs, right?
Right.
Therein lies the problem with the financing of health care. Both the government and 'pre-paid health care' packaged like it's insurance are contributors to the problem.
And THAT is why it's not fair for the drug companies to charge what they charge. Not because they do, but because the gov't enables it by removing real competition. It does so by propping up insurance companies with employer subsidized insurance that makes the gov't and your employers the customer. You are left out to dry. And that is by design.
There IS a way around patents. My proton pump inhibitor, Prilosec, just when off OTC patent. I now buy it super cheap. Before that, it was still on patent, but OTC - cheaper than prescription. Why would I use Nexium when the much cheaper OTC Prilosec was readily available? Before THAT - well, I used an H2 blocker, Pepcid. I had choices. Same with my bp med. I currently use an expensive combo drug, lotrel. Why do I care what it costs; I don't pay for it? But. If I DID pay for it, you better believe that I would be getting a generic CA blocker and ACE inhibitor - probably both on Wal-mart's $4 list!!!!! So, any new fangled patented BP med, say, the new ARBs, have to compete with what's out there.
Incidentally, ever notice has much the price drops when a drug goes from being prescription only to OTC? Know why? It's cheaper to make? No. Why is because the prescription market is a form of third party buffer against competition. In most cases, you don't pick out your prescription drugs; your doctors do. You have a say, but that say is buffered. When a drug comes out OTC, you have MUCH to say about the product. Same argument as above; when I can directly compare prices of a generic H2 blocker to a patented OTC PPI, then there is a limit to what the market will bear. And. Surprise. The market suddenly and efficiently reflects that difference.
Their prices would have to reflect the true competition of the market. Since the government currently buffers that competition, that means the companies can charge what they like. And, do.
The solution is the free market. That's not what we have, now.
Re response 18 , the arguement seems to be that as I am not the customer ,I don't care how much the drug company charges , so they charge astronomical amounts for new drugs ( that do not have competitors ) .That maybe true of me , but I would have thought the private insurance companies would be able to pressure upon the drug suppliers to reduce prices , but they do not seem able to do this .
Maybe this is where economy of scale comes into play , if you are a larger customer the supplier has to respond to your downward pressure upon the prices you can charge ( a la Walmart) .
Re response 18 , the arguement seems to be that as I am not the customer ,I don't care how much the drug company charges , so they charge astronomical amounts for new drugs ( that do not have competitors ) .That maybe true of me , but I would have thought the private insurance companies would be able to pressure upon the drug suppliers to reduce prices , but they do not seem able to do this .
Maybe this is where economy of scale comes into play , if you are a larger customer the supplier has to respond to your downward pressure upon the prices you can charge ( a la Walmart) .
The problem is that both the insurance companies AND the pharmaceuticals depend upon gov't to protect them from true competition. It would be the pot calling the kettle black for either to demand of the other a true competitive market. In any case, when the cost of care is so bloated because of the third party payor system, why quibble? There's plenty of slush to make a whole slew of multi-millionaires, in both camps.
Besides, on what basis could the insurance companies pressure the drug companies? What leverage do they really have? The insurance companies have sold a product and that product is complete pre-paid care. To some extent, they DO try to control their formularies. But that is a limited proposition in the day of direct-to-consumer drug advertising. I want my purple pill and I don't care how much it cost.
I think some of Wal-mart's action is to blunt the criticism that it is bad for communities. How could a company that provides such a critical service be so bad? In any case, I suspect that it's a loss leader. But, in true competitive form, two local grocery stores are almost matching Wal-mart: 5 dollar/drug, 10/90-day supply. I'm thinking they all lose money on their generic lists and intend to make it back on their patented drugs. People generally fill all their prescriptions at the same place.
In turn, the sheer quantity of drugs being moved by being on that list IS likely incentive enough for generic makers to lower prices to find their way on the list. You make money by selling a few of something expensive, OR, a whole lot of something inexpensive. That 4 dollar list is changing the drug market, at least on the low end. We need to bring change to the high end. This will be how. When Wal-mart adopts a $24 dollar name-brand list, the market will turn on its head. The pressure to get their drugs on THAT list will seriously change the marketing - AND PRICING - of patented drugs.
I think Wal-mart might also make some serious inroads with its in-store clinics that are coming. In both cases, this is direct free marketing to the consumer: who cares what your third party will pay if I can beat the spread of their co-pays?
Right on. Health care needs a whole lot more of that.
"A ban on smokers and the obese getting certain NHS treatments in some parts of the country was defended by Health Secretary Patricia Hewitt today.
She said it was “perfectly legitimate” for primary care trusts (PCTs) to set a collective policy to deny operations to certain patients.
Ms Hewitt was responding to a Sky News survey which found nine PCTs refused joint replacements to obese patients and four blocked orthopaedic surgery for smokers. "
~faith,
Timothy.
Not sure that I disagree with this stance, we work hard to optimise out patients conditions pre-operatively and I have suspended patients on a waiting list because they have a high BMI as the clinical risk is increased and along with other co-morbidities. The types are surgery they were listed for are routine, non emergency stuff that was not impacting on thier lives. This is similar for heavy smokers, and we are not talking someone who smokes 5 a day but heavy smokers who again have increase clinical risk due to respiratory and cardiovascular complications of smoking.
I don't think this is a bad thing to be doing, also these are clinical decisions made by the doctors and other healthcare providers of these patients, not made by the government.
There is no way any emergency surgery would be refused because of weight or smoking.
Additionally you keep referring to the waiting times, but again the NHS has made massive progress in reducing these times and the majority of health care trusts now have waiting times down to under 18 weeks from time of referral to time of treatment for elective non urgent stuff and we have a 4 week target from referral to treatment for cancer patients, that includes investigations.
Not sure that I disagree with this stance, we work hard to optimise out patients conditions pre-operatively and I have suspended patients on a waiting list because they have a high BMI as the clinical risk is increased and along with other co-morbidities. The types are surgery they were listed for are routine, non emergency stuff that was not impacting on thier lives. This is similar for heavy smokers, and we are not talking someone who smokes 5 a day but heavy smokers who again have increase clinical risk due to respiratory and cardiovascular complications of smoking.
I don't think this is a bad thing to be doing.
There is no way any emergency surgery would be refused because of weight or smoking.
Additionally you keep referring to the waiting times, but again the NHS has made massive progress in reducing these times and the majority of health care trusts now have waiting times down to under 18 weeks from time of referral to time of treatment for elective non urgent stuff and we have a 4 week target from referral to treatment for cancer patients, that includes investigations.
There is a different frame of reference here. YOU think 18 weeks/4 weeks is great because it's a REDUCTION in wait times. For me, that would be an unfathomable wait.
In addition, smoking/obese denials are slippery slopes. For a health bureau desperate to reduce costs, denials of service are dangerous ways to contain those costs. One of the chief arguments HERE in favor OF gov't run health care is that the insurance companies routinely find ways to deny treatment. Turns out, so does the NHS.
Then there is the denial of "futile care". To some extent, I could agree with this concept. We've all worked with patients that we all KNEW would be better off dead. There ARE things worse than dying. But. The American people are not prepared to go to those lengths, NECESSARY LENGTHS, to finance a public system. If even partially implemented, it will be a PR disaster to tell a family member that Momma's vent WILL be turned off, not out of respect of anybody's wishes, but rather, because that's the economical thing to do.
In fact, those that advocate gov't run health care here LONG AGO stopped using NHS as a positive frame of reference. They moved on to Canada. Then, when the Canadian Supreme Court ruled, "Access to a waiting list is NOT access to health care", then those that advocate for gov't run health care moved on again. Now, it seems, France is being hyped, even though the French gov't is proclaiming that their program is in a financing crisis.
I can't agree that when the gov't corners the market on care that it should also be in the business of denying that care. It comes down to this: it's not just a denial of care; it's a denial of a choice of alternatives. That's not very fair.
"45-year-old Leslie Burke is suing for the right to receive food and water via a feeding tube if his neurologic disease renders him unable to swallow."
"An assessment is made of the cost of treatment per additional year of life which it brings, and per quality adjusted life year (QALY).... [This] is then used as the basis for a recommendation as to whether or not...the treatment should be provided in the NHS... The Secretary of State believes that...clinicians should be able to follow NICE guidelines without being obliged to accede to patients' demands.... If that principle were undermined, there would be considerable risk of inefficient use of NHS resources."
"A prominent British physician (said): "Burke is only thinking of himself rather than looking at the bigger picture."
I just don't think the American public will adapt well to this concept. That last statement is tantamount to, "Why don't you just die for the greater good." That starts to smack of eugenics.
The chief problem with any of these denials of service is that they come on the heels of the gov't obliterating any alternative. It all comes back to choice. Choice is freedom.
If the gov't demands participation in its system, then the gov't cannot be in the business of denying care. Period. Of course, the gov't also cannot afford to provide care UNLESS it denies care to many. Cost effectiveness analysis is about just that: balancing cost with quality of life. It's a great theoretical exercise UNTIL it's YOUR life they are balancing by cost. In the end, though, it's a catch-22. Proponents argue that gov't care is a more equitable way to provide care by sharing the cost. After all, nobody should be denied care due to inability to pay. And yet, it is still a hugely inequitable deal if YOU are denied care in the gov't system, based on an inability of the State to pay for it.
Don't treat the old and unhealthy, say doctors Jan 08:
"Smokers, heavy drinkers, the obese and the elderly should be barred from receiving some operations, according to doctors, with most saying the health service cannot afford to provide free care to everyone."
There is a different frame of reference here. YOU think 18 weeks/4 weeks is great because it's a REDUCTION in wait times. For me, that would be an unfathomable wait.
~faith,
Timothy.
No, I think it's progress which is great.
I like the fact that at the moment I am unable to work due to an injury and surgery. I don't have to worry about being able to afford healthcare because I have already paid for it and I can access it as and when I need. I don't have to worry about money because as an employee of the health service I get full pay for 6 months off sick, and then if needed a further 6 months at half pay.
As a patient I have only had excellent expereinces of our healthcare, my wait for surgery was a personal choice it could have been done much sooner but I chose when.
ZASHAGALKA, RN
3,322 Posts
http://www.timesonline.co.uk/tol/news/uk/health/article1722284.ece
Govt defends NHS ban on smokers and obese
"A ban on smokers and the obese getting certain NHS treatments in some parts of the country was defended by Health Secretary Patricia Hewitt today.
She said it was "perfectly legitimate" for primary care trusts (PCTs) to set a collective policy to deny operations to certain patients.
Ms Hewitt was responding to a Sky News survey which found nine PCTs refused joint replacements to obese patients and four blocked orthopaedic surgery for smokers. "
~faith,
Timothy.