A decision to rescind endorsement of the drug would reignite the highly charged debate over UShealth care reform and how much the state should spend on new and expensive treatments.
Avastin, the world’s best selling cancer drug, is primarily used to treat colon cancer and was approved by the US Food and Drug Administration in 2008 for use on women with breast cancer that has spread.
It costs $8,000 (£5,000) a month and is given to about 17,500 women in the US a year. The drug was initially approved after a study found that, by preventing blood flow to tumours, it extended the amount of time until the disease worsened by more than five months. However, two new studies have shown that the drug may not even extend life by an extra month.
The FDA advisory panelhas now voted 12-1 to drop the endorsement for breast cancer treatment. The panel unusually cited “effectiveness” grounds for the decision. But it has been claimed that “cost effectiveness” was the real reason ahead of reforms in which the government will extend health insurance to the poorest.
If the approval of the drug is revoked then US insurers would be likely to stop paying for Avastin.
Donald Berwick is no household name, but President Obama just handed him immense power to shape what kind of health care will be available to every American man, woman and child.
Berwick is the president’s newly appointed administrator of the Centers for Medicare and Medicaid Services, the federal agency that is ground zero for Obamacare’s politicization of American medicine. Obama installed Berwick with a recess appointment, a rarely exercised authority given to the president by the Constitution to use when the Senate is out of session for long periods. Berwick will have the job until the end of 2011. He assumes his duties without a Senate confirmation hearing or a Senate vote on his nomination.
Here’s another name few Americans are likely to recognize: Linda O’Boyle. According to the London Sunday Times, O’Boyle died in 2008 after British National Health Service officials cut off her “free” treatment by government doctors. Her sin was that she used her life savings to pay for an unapproved cancer drug earlier in the year. Her doctors had told her the drug, cetuximab, was markedly more effective in combating bowel cancer than the NHS-approved chemotherapy. Unfortunately, cetuximab was rejected by NHS officials as “not cost-effective.” O’Boyle, an NHS occupational therapist, was dead within a few months, a victim of rationed health care. She was also one of the tragic human beings behind a statistic Obama and Berwick likely hope you never hear about: Britain’s cancer survival rate ranges between 40.2 percent and 48.1 percent for men and between 48 percent with 54.1 percent for women, compared with 66 percent for U.S. men and 63 percent for U.S. women.
Now consider this quote from Berwick: “Cynics beware, I am romantic about the National Health Service, I love it.” Here’s another Berwick quote: “The decision is not whether or not we will ration care, the decision is whether we will ration with our eyes open.” It is bad enough that Obama would nominate an individual who holds such views to head Medicare and Medicaid. To install him under a recess appointment with no Senate hearing and no Senate confirmation vote is an arbitrary act of an imperial presidency so outrageous as to embarrass even Richard Nixon. Since Berwick can only occupy the position for approximately 17 months, the question inevitably arises: What does Obama want Berwick to do that is so important that it justifies circumventing the Senate’s constitutional duty to advise and consent on presidential appointments?
The new healthcare law will pack 32 million newly insured people into emergency rooms already crammed beyond capacity, according to experts on healthcare facilities.
A chief aim of the new healthcare law was to take the pressure off emergency rooms by mandating that people have insurance coverage. The idea was that if people have insurance, they will go to a doctor rather than putting off care until they faced an emergency.
People who build hospitals, however, say newly insured people will still go to emergency rooms for primary care because they don’t have a doctor.
“Everybody expected that one of the initial impacts of reform would be less pressure on emergency departments; it’s going to be exactly the opposite over the next four to eight years,” said Rich Dallam, a healthcare partner at the architectural firm NBBJ, which designs healthcare facilities.
“We don’t have the primary care infrastructure in place in America to cover the need. Our clients are looking at and preparing for more emergency department volume, not less,” he said.
Some Democrats agree with this assessment.
Rep. Jim McDermott (D-Wash.) suspects the fallout that occurred in Massachusetts’ emergency rooms could happen nationwide after health reform kicks in.
Massachusetts in 2006 created near-universal coverage for residents, which was supposed to ease the traffic in hospital emergency rooms.
But a recent poll by the American College of Emergency Physicians found that nearly two-thirds of the state’s residents say emergency department wait times have either increased or remained the same.
A February 2010 report by The Council of State Governments found that wait times had not abated since the law took effect.
In 301 AD, the Roman emperor Diocletian imposed price controls on most commodities and professions in the empire. The penalty for raising prices was death. Yet the controls failed utterly, leading to shortages, more inflation and the near collapse of the imperial economy.
Now, nearly two millennia later, President Obama seems determined to demonstrate how little we’ve learned.
Yesterday, the president proposed giving the federal government the power to regulate insurance premiums. Undoubtedly, this will be politically popular — at least, in the short term. Insurance companies aren’t exactly America’s most loveable industry. Recent premium hikes will result in real hardship for many Americans.
There is, of course, a certain arrogance in the assumption that Obama, Nancy Pelosi and a bevy of government bureaucrats know exactly what something should cost. No doubt, as soon as they finish setting insurance prices, they’ll move on to negotiating Tracy McGrady’s contract renewal.
But more important, attempts to control prices by government fiat ignore basic economic laws — and the result could be disastrous for the American health-care system.
Most people think of prices and costs as the same thing, but from an economic perspective, they aren’t. Prices are what people pay to receive a good or service. Costs are what it takes to produce the goods and services. In this case, limiting the prices that insurers can charge does nothing about the underlying costs of health care.
Insurers unable to charge more for an increasingly expensive product can be expected to trim costs in one of two ways:
They can drop their most expensive customers — in this case, the sickest, who consume the most health care. Many companies are already doing this, a major source of dissatisfaction with the health-care system. In fact, the president wants to prohibit companies from doing this.
They can cut back on their reimbursement rates to hospitals and physicians. But neither doctors nor hospitals, any more than insurance companies, are willing to operate at a loss. If payments fall below their costs, they’ll simply stop taking patients. One only has to look at government programs like Medicare and Medicaid to see how this works.
Medicare already reimburses at roughly 80 cents on every dollar of actual costs. Medicaid pays even less. As a result, more than a third of physicians have closed their practices to Medicaid patients; 12 percent no longer accept Medicare patients.
If private insurers begin similarly to cut back their reimbursements, some hospitals may go out of business, and some doctors may close their practices. Retirement in Florida may begin to look a lot better than another snowy New York winter. Others will stop accepting insurance or set up “concierge” practices in which they see only a small number of privately paying patients.
Thus, price controls on insurers will ultimately lead to rationing — the lack of available health-care goods and services.
Your excellent editorial “The ‘Cost Control’ Bill of Goods” (Dec. 14) doesn’t emphasize a potential stealth cost-control aspect proposed in the bill. It will start pilot programs that would transfer the gatekeeper role to doctors at the bedside, a role currently held by “payers” (HMOs and government-agency insurers, including Medicare and Medicaid).
The transfer will be via capitation fee payments, making clinics “responsible” for the cost of care of “insured lives” for one year. Like the more powerful payers, such clinics must restrict orders for care—or go broke. The clinicians’ other choice is to be left out of the income stream, if they are not incorporated in a comprehensive “provider accountable care organization.” These will bid for capitation fee rates at payer population auctions of the insured lives to be serviced.
The illusion of many pundits and policy makers is that mini provider gatekeepers can control costs after the very powerful payer gatekeepers have failed for decades. The problem for patients is the dilemma of all managed-care gatekeepers: cost, quality, access; pick any two. It is not pleasant to think that one’s gatekeeper doctor will have to decide whether to order surgery for your painful hip or only to increase the dose of Ibuprofen—a choice that patients won’t know about, since managed-care corporations and capitated doctors rationing care are carefully hidden behind the Orwellian double-speak of “pay for quality, not quantity,” “well care, not sick care,” “responsibility,” “accountability,” “pay for outcomes,” and other artful illusions.
The economic reality is that no rationing of care supply will ever control costs, when the problem is demand inflation driven by popular insurance tax subsidies too sacred to repeal. Consider that when federal fiscal “necessity” overwhelms empty slogans, scores of new bureaucracies created in ObamaCare would be able to implement Draconian rationing in collusion with subservient insurance and “provider” corporations. The high costs, as well as the rationing powers included in the more than 2,000 pages of the Obama Care Senate legislation are very real.
Government guidelines would likely have forbidden the test I used to discover my wife’s cancer.
By SENATOR TOM COBURN – I recently suggested that seniors will die sooner if Congress actually implements the Medicare cuts in the health-care bill put forward by Senate Majority Leader Harry Reid. My colleagues who defend the bill—none of whom have practiced medicine—predictably dismissed my concern as a scare tactic. They are wrong. Every American, not just seniors, should know that the rationing provisions in the Reid bill will not only reduce their quality of life, but their life spans as well.
My 25 years as a practicing physician have shown me what happens when government attempts to practice medicine: Doctors respond to government coercion instead of patient cues, and patients die prematurely. Even if the public option is eliminated from the bill, these onerous rationing provisions will remain intact.
For instance, the Reid bill (in sections 3403 and 2021) explicitly empowers Medicare to deny treatment based on cost. An Independent Medicare Advisory Board created by the bill—composed of permanent, unelected and, therefore, unaccountable members—will greatly expand the rationing practices that already occur in the program. Medicare, for example, has limited cancer patients’ access to Epogen, a costly but vital drug that stimulates red blood cell production. It has limited the use of virtual, and safer, colonoscopies due to cost concerns. And Medicare refuses medical claims at twice the rate of the largest private insurers.
Section 6301 of the Reid bill creates new comparative effectiveness research (CER) programs. CER panels have been used as rationing commissions in other countries such as the U.K., where 15,000 cancer patients die prematurely every year according to the National Cancer Intelligence Network. CER panels here could effectively dictate coverage options and ration care for plans that participate in the state insurance exchanges created by the bill.
Additionally, the Reid bill depends on the recommendations of the U.S. Preventive Services Task Force in no fewer than 14 places. This task force was responsible for advising women under 50 to not undergo annual mammograms. The administration claims the task force recommendations do not carry the force of law, but the Reid bill itself contradicts them in section 2713. The bill explicitly states, on page 17, that health insurance plans “shall provide coverage for” services approved by the task force. This chilling provision represents the government stepping between doctors and patients. When the government asserts the power to provide care, it also asserts the power to deny care.
A government panel of doctors and scientists recommended Monday that women in their forties should not have annual mammograms and older women should reduce their use of the screening device. The U.S. Preventive Services Task Force (USPSTF) concluded that early and frequent breast cancer screenings often lead to false alarms and unneeded biopsies without substantially improving women’s odds of survival.
Nicole Kurokawa, a senior policy analyst at the Independent Women’s Forum, says the recommendation by the government task force brings the U.S. in line with British policy.
“Unfortunately what Britain has, as a result of their policy, is a 69-percent, five-year survival rate for breast cancer; whereas the U.S. right now has a much better survival rate — our survival rate’s about 84 percent,” she points out. “And that’s really not a system that we want here, particularly with a disease like breast cancer.”
The analyst explains that with breast cancer, early detection is key to survival rates. “And in pushing detection back, what we’re doing is…sending a message that it’s just not important,” she laments.
Kurokawa says the new mammogram advice from the USPSTF reaffirms that when the government is in control of healthcare, Americans are really going to suffer.
In fact, concern has been expressed in media interviews that the new guidelines represent a form of healthcare rationing that puts financial considerations above lives. On Wednesday, Heath and Human Services (HHS) Secretary Kathleen Sebelius tried to distance her agency from the Task Force’s recommendations, stating she would be “very surprised if any private insurance company changed its mammography coverage decisions as a result of this action.”
The Task Force advises HHS, and its members are appointed by the HHS. None of the current 16 members are oncologists.
Meet the unelected body that will dictate future medical decisions.
As usual, the most dangerous parts of ObamaCare aren’t receiving the scrutiny they deserve—and one of the least examined is a new commission to tell Congress how to control health spending. Democrats are quietly attempting to impose a “global budget” on Medicare, with radical implications for U.S. medicine.
Like most of Europe, the various health bills stipulate that Congress will arbitrarily decide how much to spend on health care for seniors every year—and then invest an unelected board with extraordinary powers to dictate what is covered and how it will be paid for. White House budget director Peter Orszag calls this Medicare commission “critical to our fiscal future” and “one of the most potent reforms.”
On that last score, he’s right. Prominent health economist Alain Enthoven has likened a global budget to “bombing from 35,000 feet, where you don’t see the faces of the people you kill.”
As envisioned by the Senate Finance Committee, the commission—all 15 members appointed by the President—would have to meet certain budget targets each year. Starting in 2015, Medicare could not grow more rapidly on a per capita basis than by a measure of inflation. After 2019, it could only grow at the same rate as GDP, plus one percentage point.
The theory is to let technocrats set Medicare payments free from political pressure, as with the military base closing commissions. But that process presented recommendations to Congress for an up-or-down vote. Here, the commission’s decisions would go into effect automatically if Congress couldn’t agree within six months on different cuts that met the same target. The board’s decisions would not be subject to ordinary notice-and-comment rule-making, or even judicial review.
Yet if the goal really is political insulation, then the Medicare Commission is off to a bad start. To avoid a senior revolt, Finance Chairman Max Baucus decided to bar his creation from reducing benefits or raising the eligibility age, which meant that it could only cut costs by tightening Medicare price controls on doctors and hospitals. Doctors and hospitals, naturally, were furious.
On Monday, October 19, Senator Jon Kyl of Arizona shared with his colleagues in the Senate what he has been hearing from his constituents on Health Care Reform. Senator Kyl gave a 20-minute presentation in which he aptly articulated the concerns most Americans are expressing about the Health Care Reform bill. Although it is a bit long, this is a “must-see” speech for everyone who cares about the future of health care in America.
By John C. Goodman — Lies and distortions,” said David Axelrod in an e-mail to 13 million of the Obama faithful plus an untold number of others who were spammed. He was referring to criticisms of the Obama health-care-reform plan—criticisms that are hitting the mark, to judge by opinion polls and the near-riotous responses members of Congress have gotten at town-hall meetings.
Chief among the White House’s irritations is Sarah Palin’s accusation that Obama would create “death panels” to decide who lives and who dies. It is true that none of the bills before Congress calls for the creation of such entities, but does Palin’s statement, however hyperbolic, point toward legitimate concerns? Is there something we should be worried about? The answer is: Yes, we should be very worried.
In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.
Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.
But this approach can also mask the signs that their condition is improving, the experts warn.
As a result the scheme is causing a “national crisis” in patient care, the letter states. It has been signed palliative care experts including Professor Peter Millard, Emeritus Professor of Geriatrics, University of London, Dr Peter Hargreaves, a consultant in Palliative Medicine at St Luke’s cancer centre in Guildford, and four others.
“Forecasting death is an inexact science,”they say. Patients are being diagnosed as being close to death “without regard to the fact that the diagnosis could be wrong.
“As a result a national wave of discontent is building up, as family and friends witness the denial of fluids and food to patients.”
The warning comes just a week after a report by the Patients Association estimated that up to one million patients had received poor or cruel care on the NHS.
President Barack Obama and Congressional Democrats are rushing to enact legislation that would overhaul the way health care is financed and delivered in the United States. It would dramatically increase the role of government in virtually all aspects of health care. Such an initiative should be carefully studied to determine whether it actually solves problems in the health care arena or makes them worse.
National health plans similar to what President Obama is proposing have been adopted in other countries. They always start out promising universal access and free or reduced-price health care. But they end up with massive institutional bureaucracies whose purpose and function are to deny health care and medical services. Often they fail to control spending despite resorting to withholding care to politically weak groups.
President Obama insists that his plan to fundamentally restructure health care is needed to reduce costs. He has touted a report from his Council of Economic Advisors that specifies exactly how that would be done. That report, however, elaborates a policy of thorough government health care rationing achieved through government control of the financing and delivery of care.
This study will explain how the health policy changes President Obama and Congressional Democrats support would cause millions of Americans to lose their choice of doctors and insurance coverage, require that access to care be strictly rationed, and cause the quality of care to deteriorate. Despite all this sacrifice, nationalizing health insurance in America would require major tax increases, slow economic growth, and increase the national debt.
Part 2 of this study describes the Obama health plan as it is presented in legislation being debated in Congress. Part 3 explains how the Obama health plan would result in the loss of freedom of choice. In particular, it shows how you would not be free under President Obama’s plan to keep your current health insurance because employers would “dump”millions of people into a one-size-fits-all government-run program. Part 4 explains how the Obama plan would give government the power to ration health care, including the power to deny access to the elderly, who need it the most.
Part 5 explains how, despite rationing, the Obama health plan would increase health costs. Part 6 describes the intractable entitlement crisis America already faces based on the undeliverable promises made for Social Security, Medicare, and Medicaid. The Obama health plan would recklessly add yet another unfunded middle-class entitlement program, this one giving subsidies for families earning $88,000 per year and more.
Part 7 discusses the health policy reforms America should adopt, based on expanding patient power and choice in a market-based health care system. These reforms would provide a true health care safety net that would ensure no one suffers without essential health care while reducing costs and preserving those parts of the current health care system that work. Part 8 presents a brief summary and concluding remarks.
Today, Americans enjoy the best health care and medical services in the world, an important part of our high standard of living. President Obama has said “my view is that health care reform should be guided by a simple principle: fix what’s broken and build on what works.” But that is not what his plan would do. Instead, he would tear down what is good about the current system and replace it with old-fashioned and outdated socialized medicine policies adopted by other countries, reflecting their lower living standards. It would be a terrible mistake.
From Oregon comes a story almost hard to believe. Barbara Wagner, a Springfield, Oregon woman’s doctor hoped a new chemotherapy drug would help her but the Oregon Health Plan sent her a letter telling her they would not pay for the treatment, but would pay for assisted suicide.
And Mrs. Wagner is not the only one to get a letter.
53-year-old Randy Stroup of Dexter, Ore., has been in a fight for his life. Uninsured and unable to pay for expensive chemotherapy, he applied to Oregon’s state-run health plan for help.
Lane Individual Practice Association (LIPA), which administers the Oregon Health Plan in Lane County, responded to Stroup’s request with a letter saying the state would not cover Stroup’s pricey treatment, but would pay for the cost of physician-assisted suicide.
Even before the current debate on health care the Democrats were laying the ground work for potential rationing in a government controlled system. Within the stimulus bill passed in February the legislation created a “Federal Coordinating Council for Comparative Effectiveness Research.” The report issued by the House Appropriations Committee explained what they hoped to accomplish with this “research”
By knowing what works best and presenting this information more broadly to patients and healthcare professionals, those items, procedures and interventions that are most effective to prevent, control and treat health conditions will be utilized¸ while those that are found to be less effective and in some cases, more expensive¸ will no longer be prescribed. (Emphasis added)
The concerns over rationing in the current health care debate come from a number of different places, including the fact the provision on “end-of-life” planning for seniors in the House bill comes from Rep. Earl Blumenauer, a Democratic congressman from Oregon who supported Oregon’s assisted suicide law.
Additionally President Obama himself has made several public statements indicating the federal government would be making decisions on what sort of treatments people get, including in this New York Times piece where he stated:
“(T)here is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance.”
The “independent group” he refers to would be a government run entity and most likely take form in the “Federal Coordinating Council for Comparative Effectiveness Research.”
The Republicans tried at least five different times to ensure that “comparative effectiveness research” is not used for rationing purposes. Three times in the Senate Health, Education, Labor and Pensions Committee and twice in the House of Representatives (once in Ways and Means and once in Energy and Commerce). Each time the Democrats on the committees voted the amendments down (House results are here and here.)
Rationing takes place in health care, that is the simple and sad truth of any system. However when it is a government entity making those decisions, with little input from the patients and doctors directly effected, you end up with the Kevorkian “cost saving” moves of the state of Oregon where they will take your liberties and give you death.
This video is an excerpt of the testimony of Richard Baker to the Health Care Solutions Committee on July 23, 2009. Mr. Baker offers examples of problems he has personally witnessed with the Canadian single payer health care system. Mr. Baker was one of four expert witnesses testifying against plans to adopt a government heath care system in the US. The entire video can be viewed at http://www.c-span.org/Watch/Media/200…
A decision to rescind endorsement of the drug would reignite the highly charged debate over US health care reform and how much the state should spend on new and expensive treatments.
The new healthcare law will pack 32 million newly insured people into emergency rooms already crammed beyond capacity, according to experts on healthcare facilities.
In 301 AD, the Roman emperor Diocletian imposed price controls on most commodities and professions in the empire. The penalty for raising prices was death. Yet the controls failed utterly, leading to shortages, more inflation and the near collapse of the imperial economy.
Your excellent editorial “
By SENATOR TOM COBURN – I recently suggested that seniors will die sooner if Congress actually implements the Medicare cuts in the health-care bill put forward by Senate Majority Leader Harry Reid. My colleagues who defend the bill—none of whom have practiced medicine—predictably dismissed my concern as a scare tactic. They are wrong. Every American, not just seniors, should know that the rationing provisions in the Reid bill will not only reduce their quality of life, but their life spans as well.
As usual, the most dangerous parts of ObamaCare aren’t receiving the scrutiny they deserve—and one of the least examined is a new commission to tell Congress how to control health spending. Democrats are quietly attempting to impose a “global budget” on Medicare, with radical implications for U.S. medicine.
By John C. Goodman — Lies and distortions,” said David Axelrod in an e-mail to 13 million of the Obama faithful plus an untold number of others who were spammed. He was referring to criticisms of the Obama health-care-reform plan—criticisms that are hitting the mark, to judge by opinion polls and the near-riotous responses members of Congress have gotten at town-hall meetings.
In 
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