On Death and Healthcare

Virginia Postrel's essay on the cancer drug Herceptin should be required reading for anyone who's advocating a single-payer national health care system. This is one of those stories that once it sinks in, your body starts to shudder at the thought of your own potential death from state-rationed medical care. Postrel's breast cancer was expected to be early-stage, small, and cured by routine treatment. But when an MRI revealed a much more dreadful escalation of the disease, the miracle of modern drugs - in the American system of medical innovation and provision - saved her life:

Starting in the late 1990s, oncologists had used Herceptin to extend the lives of patients whose HER2-positive cancers were advanced and metastatic, buying them months, and in some cases years, of life. Then, in May 2005, reports of clinical trials on patients with early-stage HER2-positive breast cancer electrified the American Society of Clinical Oncology’s annual meeting. Herceptin halved the chances of cancer recurrence: from one in six to one in 12 after two years. No one knew what would happen after five or 10 years, but the preliminary results were, to quote a New England Journal of Medicine editorial, “stunning.”

For breast cancer that hasn’t spread elsewhere in the body, Herceptin offers the possibility of a cure. It enhances chemotherapy, encourages the immune system to attack cancer cells, and hinders those cells from reproducing. A year of the drug, with one dose every three weeks (or, for some patients, along with weekly chemotherapy), is now the international standard of care for patients with cancers like mine. So, along with chemotherapy, another round of surgery, and seven and a half weeks of daily radiation, that’s what I got. The Herceptin treatments cost my insurer about $60,000. A year later, I have no evidence of disease and, though it’s still early, I have hope of staying that way indefinitely.

Not everyone in similarly rich countries is so lucky—something to remember the next time you hear a call to “tame runaway medical spending.” Consider New Zealand. There, a government agency called Pharmac evaluates the efficacy of new drugs, decides which drugs are cost-effective, and negotiates the prices to be paid by the national health-care system. These functions are separate in most countries, but thanks to this integrated approach, Pharmac has indeed tamed the national drug budget. New Zealand spent $303 per capita on drugs in 2006, compared with $843 in the United States. Unfortunately for patients, Pharmac gets those impressive results by saying no to new treatments. New Zealand “is a good tourist destination, but options for cancer treatment are not so attractive there right now,” Richard Isaacs, an oncologist in Palmerston North, on New Zealand’s North Island, told me in October.

A more centralized U.S. health-care system might reap some one-time administrative savings, but over the long term, cutting costs requires the kinds of controls that make Americans hate managed care. You have to deny patients some of the things they want, including cancer drugs that are promising but expensive.

Be sure to read the whole thing, here.

"Frightening" is a good one-word description of the left's calls for socialized medicine.

Maybe that's why President Barack Obama is looking to suspend the Senate's filibuster rule for the upcoming healthcare vote. Knowing that he wouldn't be getting 60 senators voting on socializing American medicine, the administration's moved once again to rely on authoritarianism and stealth to ram through changes adverse to the American public interest.

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