Comments on: The Market for Suboptimal Cancer Care http://www.concurringopinions.com/archives/2007/07/the_market_for.html The Law, the Universe, and Everything Sat, 21 Nov 2009 21:19:19 -0700 http://wordpress.org/?v=2.8.3 hourly 1 By: Betsy de Parry http://www.concurringopinions.com/archives/2007/07/the_market_for.html/comment-page-1#comment-53167 Betsy de Parry Mon, 16 Jul 2007 21:40:15 +0000 http://www.solove.org/archives/2007/07/the-market-for-suboptimal-cancer-care.html#comment-53167 I am one of the patients Alex Berenson interviewed for the Times article. As the author of a book about my experience with lymphoma, I regularly hear from patients around the country. Few are offered Bexxar or Zevalin as options. The most common "reasons" are outlined in an essay I recently wrote for our local newspaper, The Ann Arbor News. The link follows: http://www.mlive.com/annarbor/stories/index.ssf?/base/news-0/1181458985115390.xml&coll=2 What is also disturbing is the cost of treatment. When the cost of chemotherapy-related side effects is added the cost of the drugs themselves, the result is that Bexxar and Zevalin are bargains! My actual costs, which I cite in the essay, were $36,929.50 for RIT, including the drugs, scans and all necessary medical visits. In a twelve month period, the additional costs for chemotherapy and chemotherapy-related side effects was $162,409.72. If Bexxar and Zevalin were used more frequently, everyone would win. Insurers could save thousands by simply providing incentives for oncologists to use the drugs. Since the treatment takes only one week, patients could avoid months of treatment and side effects and get back to their lives much faster. And employers would have employees back to work quicker. I am enormously grateful to Alex Berenson and The New York Times for shining the light on this unfortunate situation. As I stated in the article, I truly believe that patients with all types of illnesses deserve to know all their options. It is only too bad that we patients must often find them for ourselves. Betsy de Parry Author, "The Roller Coaster Chronicles" I am one of the patients Alex Berenson interviewed for the Times article. As the author of a book about my experience with lymphoma, I regularly hear from patients around the country. Few are offered Bexxar or Zevalin as options. The most common “reasons” are outlined in an essay I recently wrote for our local newspaper, The Ann Arbor News. The link follows:

http://www.mlive.com/annarbor/stories/index.ssf?/base/news-0/1181458985115390.xml&coll=2

What is also disturbing is the cost of treatment. When the cost of chemotherapy-related side effects is added the cost of the drugs themselves, the result is that Bexxar and Zevalin are bargains! My actual costs, which I cite in the essay, were $36,929.50 for RIT, including the drugs, scans and all necessary medical visits. In a twelve month period, the additional costs for chemotherapy and chemotherapy-related side effects was $162,409.72.

If Bexxar and Zevalin were used more frequently, everyone would win. Insurers could save thousands by simply providing incentives for oncologists to use the drugs. Since the treatment takes only one week, patients could avoid months of treatment and side effects and get back to their lives much faster. And employers would have employees back to work quicker.

I am enormously grateful to Alex Berenson and The New York Times for shining the light on this unfortunate situation. As I stated in the article, I truly believe that patients with all types of illnesses deserve to know all their options. It is only too bad that we patients must often find them for ourselves.

Betsy de Parry

Author, “The Roller Coaster Chronicles”

]]> By: David Schwartz http://www.concurringopinions.com/archives/2007/07/the_market_for.html/comment-page-1#comment-53166 David Schwartz Mon, 16 Jul 2007 15:36:33 +0000 http://www.solove.org/archives/2007/07/the-market-for-suboptimal-cancer-care.html#comment-53166 In every insurance field, the insurer has an incentive to pay out as little money as possible, even at the expense of the insured. I think this example is theoretically interesting, but not sufficiently relevant to the real world. It is certainly true that something that costs less in the short term but more in the long term might be preferred by an insurance company that is not assured its customer will stay with it. However, realistically, people will serious illnesses don't switch insurers very often. The root cause of this specific problem is structural. The tie between doctors and insurance companies is too tight. Doctors should be interacting with patients and recommending procedures based on their professional judgment with no regard for the insurance company's procedures. They can, of course, continue to explain the insurance company's procedures and what the effect of those procedures on the patient's medical care might be. But first and foremost, they owe their patients an unbiased assessment of what they think is best. That is certainly part of what they're paying for. In every insurance field, the insurer has an incentive to pay out as little money as possible, even at the expense of the insured.

I think this example is theoretically interesting, but not sufficiently relevant to the real world. It is certainly true that something that costs less in the short term but more in the long term might be preferred by an insurance company that is not assured its customer will stay with it.

However, realistically, people will serious illnesses don’t switch insurers very often.

The root cause of this specific problem is structural. The tie between doctors and insurance companies is too tight. Doctors should be interacting with patients and recommending procedures based on their professional judgment with no regard for the insurance company’s procedures.

They can, of course, continue to explain the insurance company’s procedures and what the effect of those procedures on the patient’s medical care might be. But first and foremost, they owe their patients an unbiased assessment of what they think is best. That is certainly part of what they’re paying for.

]]> By: Scott Moss http://www.concurringopinions.com/archives/2007/07/the_market_for.html/comment-page-1#comment-53165 Scott Moss Sun, 15 Jul 2007 06:04:34 +0000 http://www.solove.org/archives/2007/07/the-market-for-suboptimal-cancer-care.html#comment-53165 I sense an attempt at snarkiness coming from Maryland C., but of an unintelligible sort. Let me ask: do you actually disagree with Frank's point that insurers: (1) have an incentive to skimp, (2) especially given how a number of people bounce from plan to plan, and (3) that this sort of cost-cutting may economically rational but socially sub-optimal, and (4) that this may be an inefficiency that's hard for market forces to discipline because of the very limited choice most Americans have as to their health plans. Seriously, what if any part do you disagree with -- or, as I suspect, does your knee jerk right when you read any criticism of the current health care system, even if the critique is that more people are dying of cancer due to the incentive structure of the health insurance industry? I sense an attempt at snarkiness coming from Maryland C., but of an unintelligible sort. Let me ask: do you actually disagree with Frank’s point that insurers:

(1) have an incentive to skimp, (2) especially given how a number of people bounce from plan to plan, and

(3) that this sort of cost-cutting may economically rational but socially sub-optimal, and

(4) that this may be an inefficiency that’s hard for market forces to discipline because of the very limited choice most Americans have as to their health plans.

Seriously, what if any part do you disagree with — or, as I suspect, does your knee jerk right when you read any criticism of the current health care system, even if the critique is that more people are dying of cancer due to the incentive structure of the health insurance industry?

]]> By: Maryland Conservatarian http://www.concurringopinions.com/archives/2007/07/the_market_for.html/comment-page-1#comment-53164 Maryland Conservatarian Sat, 14 Jul 2007 22:36:47 +0000 http://www.solove.org/archives/2007/07/the-market-for-suboptimal-cancer-care.html#comment-53164 what are the odds that it turns out all the smart people who know best how to run our health care system went to law school instead of pursuing a career in the health care industry...that's the real tragedy - that we don't earlier identify these good and noble people (i.e. Ms. Clinton)and, instead of letting them waste their time at Yale Law, push them into years of grueling study in Med School followed by long hours of research into potential cures, the success of which is not guaranteed..sigh...what a waste what are the odds that it turns out all the smart people who know best how to run our health care system went to law school instead of pursuing a career in the health care industry…that’s the real tragedy – that we don’t earlier identify these good and noble people (i.e. Ms. Clinton)and, instead of letting them waste their time at Yale Law, push them into years of grueling study in Med School followed by long hours of research into potential cures, the success of which is not guaranteed..sigh…what a waste

]]> By: BennyAbelard http://www.concurringopinions.com/archives/2007/07/the_market_for.html/comment-page-1#comment-53163 BennyAbelard Sat, 14 Jul 2007 21:38:20 +0000 http://www.solove.org/archives/2007/07/the-market-for-suboptimal-cancer-care.html#comment-53163 At yet somewhere, at this moment, Gordon Smith is repeating his trope about the American system with its fantastic "access and innovation". Don't mean to pick on Professor Smith, I'm sure lots of others are also saying such things. But isn't the whole point of this story that ordinary affluent Americans who thought they had adequate health insurance don't have access to new medical innovations? What our healthcare system provides in spades is "profits and political muscle". http://www.theconglomerate.org/2007/04/the_democratic_.html http://www.theconglomerate.org/2007/07/fred-wilson-get.html At yet somewhere, at this moment, Gordon Smith is repeating his trope about the American system with its fantastic “access and innovation”.

Don’t mean to pick on Professor Smith, I’m sure lots of others are also saying such things. But isn’t the whole point of this story that ordinary affluent Americans who thought they had adequate health insurance don’t have access to new medical innovations? What our healthcare system provides in spades is “profits and political muscle”.

http://www.theconglomerate.org/2007/04/the_democratic_.html

http://www.theconglomerate.org/2007/07/fred-wilson-get.html

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