The limits of rationed health care

NY Times:

When Bruce Hardy’s kidney cancer spread to his lung, his doctor recommended an expensive new pill from Pfizer. But Mr. Hardy is British, and the British health authorities refused to buy the medicine. His wife has been distraught.

“Everybody should be allowed to have as much life as they can,” Joy Hardy said in the couple’s modest home outside London.

If the Hardys lived in the United States or just about any European country other than Britain, Mr. Hardy would most likely get the drug, although he might have to pay part of the cost. A clinical trial showed that the pill, called Sutent, delays cancer progression for six months at an estimated treatment cost of $54,000.

But at that price, Mr. Hardy’s life is not worth prolonging, according to a British government agency, the National Institute for Health and Clinical Excellence. The institute, known as NICE, has decided that Britain, except in rare cases, can afford only £15,000, or about $22,750, to save six months of a citizen’s life.

British authorities, after a storm of protest, are reconsidering their decision on the cancer drug and others.

For years, Britain was almost alone in using evidence of cost-effectiveness to decide what to pay for. But skyrocketing prices for drugs and medical devices have led a growing number of countries to ask the hardest of questions: How much is life worth? For many, NICE has the answer.

Top health officials in Austria, Brazil, Colombia and Thailand said in interviews that NICE now strongly influences their policies.

“All the middle-income countries — in Eastern Europe, Central and South America, the Middle East and all over Asia — are aware of NICE and are thinking about setting up something similar,” said Dr. Andreas Seiter, a senior health specialist at the World Bank.

Even in the United States, rising costs have led some in Congress to propose an institute that would compare the effectiveness of new medical technologies, although the proposals so far would not allow for price considerations. At the present rate of growth, medical costs will increase to 25 percent of the nation’s gross domestic product in 2025 from 16 percent, with half of the increase coming from new drugs and devices, according to the Congressional Budget Office.

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What I find ironic about this story is that the proponents of national health care are the ones who would be most likely to use a sob story like this as a rationale for going to the British system. Isn't the argument used by the Democrats who support health care "reform" that we have to make sure that everyone has the same health care as those in Congress get? Yet, inevitably, reality intrudes and triage requires decisions from on high that otherwise would have been made by the patient or the patient's family.

At some point health care costs effect decisions that even those with unlimited resources have to consider. Whether it is a frightfully expensive drug in this case or more mundane treatments for others. Putting the government in charge does not seem to change that fact, but does make the decision seem more arbitrary.

As for the drug and its cost, we are better off in a system like we now have in the US where such drugs can be developed and if they prove effective, the cost will eventually become more affordable and it would therefore be more widely used. The British alternative is one where there is no reward for such innovation and therefore it would never be made.

Arguments are often made that we need the endangered species act because we never now when one of these plans made lead to a miracle cure. Proponents of the act have no problem in imposing cost on property owners. But as the UK has found there are limits on the cost they will impose on themselves.