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Medicare Just Increased the National Debt

April 3, 2011
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This means your children and grandchildren are now saddled with even more of the financial burden of the excesses of this generation.

It came as no surprise that Medicare approved the  new prostate cancer drug Provenge. It had to. The laws governing Medicare say it has to cover all therapies that are reasonable and necessary, no matter the cost. (Technically this approval goes into effect in about 90 days.)

Provenge is indicated for men with advanced (metastatic) prostate cancer. It costs $93,000 for a treatment and is a vaccine that helps the patients immune system fight the cancer better. How well does it work? It was shown to increase median life expectancy by four months. There are no claims of increased cures.

I saw one estimate it will cost Medicare $1 billion per year. That seems optimistic to me. If we assume every Medicare patient who dies of prostate cancer (27,000 per year) is given this drug, the drug cost alone works out to $2.5 billion per year, and that doesn’t include the treatment costs of the patients’ other medical conditions and related expenses such as nursing home costs.

Could a 95-year-old man with metastatic prostate cancer, severe heart failure, emphysema, and dementia receive this drug? Of course he could. There is nothing in the approval to withhold the drug from any patient with the indicated disease. Additionally with new technologies there is often indication creep. The drug is approved for one use but independent physicians, often under pressure from patients and families, use their “clinical judgment” to prescribe the drug to patients with less widespread disease, hoping it will make a difference.

Clinical judgment means there are no studies to tell us if patients with lesser disease actually benefit from the drug. Those doctors are just guessing.

The continued lack of courage of this generation to deal with healthcare costs directly has once again been exposed. At this rate, this habit will come to an end when America goes bankrupt and the Chinese own us.

Write your Congressperson and tell him or her to say no to over-priced drugs. Maybe this will be our moment to head the country to a place that resembles fiscal responsibility. Every journey starts with the fist step, but we have so far to go.

2 Responses to Medicare Just Increased the National Debt

  1. Chris Gregory on April 4, 2011 at 6:50 pm

    The sheer idiocy of decision making in this country leads to stories like this, where the only appropriate response on the part of the truly cost-conscious few is to shake our heads and exhale in exasperation. The British have it figured out – they WILL say NO and the Brits are taking the next progressive steps to say no to rampant costs by turning the wheel over to the generalists (i.e., PCP) physicians in the UK. Too bad we don’t have the guts. Or perhaps it is our mindless inability to react properly to the warning signs flashing steady red even as we have the sharp end of the economic pike pole jabbing us in the backside. And when it ultimately prove to be too late, we’ll stuff our hands in our pockets and ask “what happened?”.

    And yet there is the numb skull economic advisory panel of “experts” – the RUC, that advises Medicare and the commercial insurers as to the continuing low ball reimbursement of primary care physicians, with the end result that no one will want to practice medicine in the most (evidence-based) cost effective medicine in our country. Our best bang for the health care dollar will go bust because of special interests advising the maintained status quo of waste and inefficiency.

  2. Chris on December 7, 2011 at 10:40 am

    You are right the fact that Congress and the House of Representatives can not seem to get it right is so frustrating to the whole country. I don’t understand why the (inflationary) cost of medicine keeps rising and nothing is getting done about it. Oh wait I remember insurance companies and drug companies are in business to make a profit and will lobby to keep it that way. Rant over.
    Thanks,
    Chris

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