Health Insurance: Who lives, who dies? (Commentary)

[RedGlitter]

Deciding who lives and who dies

Health care rationing should be based on science, not status



COMMENTARY

By Robert Bazell

Chief science and health correspondent

NBC News

Updated: 6:55 a.m. MT July 17, 2007





When health care is rationed, the results can be heartrending.

Such a story makes for one of the most compelling episodes in "Sicko," Michael Moore's documentary about the dysfunctional U.S. health care system. In the film a Kansas woman named Julie Pierce tells of the death of her husband, Tracy, after their insurance company refused to approve a bone marrow transplant to treat his advanced kidney cancer.

While the tale is enormously sad, it conveys a totally inaccurate impression of what we need to fix health care in America.



Don’t get me wrong. As I’ve written before, I think America should have national health care just like every other industrialized nation. We are paying way too much for an irrational system that leaves huge parts of our society unprotected. Access to decent health care should be a right, not determined by whether a person has a certain job or a huge bank balance. So, I agree with the premise of Moore’s movie. I hope it provokes even more discussion about our health care crisis.But Julie Pierce’s story does not help the argument. Her husband suffered kidney cancer that had spread throughout his body before his death at age 36 in 2004. In recent years a few experimental drugs have shown some promise for treating advanced kidney cancer, but even now the diagnosis is nearly a death sentence.

Tough choices

The bone marrow transplant that the Pierce family sought has never been shown to help. A few doctors have suggested it might. The National Institutes of Health is now running two clinical trials to try to find out. Still, it is an experimental concept with little scientific basis.

Pierce implies in the movie that her insurance company and the group that runs it — the board of directors of the hospital where she works — refused to pay for the treatment because she is white and her husband was black. Of course, we know nothing of the insurance company or board's motives. In the movie, neither speaks.

Almost any insurance plan would have turned down the request for an experimental treatment, with no proven value, costing tens or hundreds of thousands of dollars. It is critical to note that the national health plans in Canada, Great Britain, France and Cuba that are featured in "Sicko" would also have turned down such treatment. No matter where he was getting his care, Tracy Pierce almost certainly would have died at a young age.

Even in the wealthiest countries, health resources are limited. Everyone cannot get every treatment they believe might help them.





The problem is, the rationing we have now in the United States is immoral. It's based on job status, wealth, luck, and all too often, profit for doctors, hospitals or health insurance companies. We must ration health care, but we should do it morally.

Science vs. status

A big step toward moral rationing is to base treatment options on good science, not status.

A horrifying example of what happens when treatments are based on anecdotes rather than science occurred in the 1980s. A few oncologists became convinced, on the basis of a handful of cases, that the best treatment for advanced breast cancer was a combination of bone marrow transplants and very high doses of chemotherapy. Insurance companies at first refused to pay, saying correctly that the treatment was experimental, unproven. As a result, the oncologists encouraged their patients to sue.

What jury could say no to a woman, often a young mother, when a doctor would testify that the treatment costing tens of thousands of dollars was her best chance for life?

When clinical trials of the bone marrow procedure were ultimately completed a decade later, they proved the procedure was actually killing the women faster than the breast cancer. More than 100,000 women underwent the marrow transplants involving untold suffering and billions of dollars in expenditures — money that could have been put to so many truly life-saving uses.

A sad story of a young person dying may make for a compelling scene before a jury or in a documentary, but it doesn’t help us know what needs to be done to fix our broken health care system.

[chonsigirl]

This is sad but true. I know, because my husband was not expected to live, health insurance will not pay for physical therapy and many regular doctor visits. Everything he has relearned, we've done it together at home. It feels good to walk out of his doctor visits, with the doctors amazed he has lived this long, and they he will live alot longer.

[spot]

RedGlitter;662703 wrote: The bone marrow transplant that the Pierce family sought has never been shown to help. A few doctors have suggested it might. The National Institutes of Health is now running two clinical trials to try to find out. Still, it is an experimental concept with little scientific basis.All true, no doubt, but the article's a deliberate refusal to look at the complaint the movie actually makes. It's somewhat misleading where it says "In recent years a few experimental drugs have shown some promise for treating advanced kidney cancer, but even now the diagnosis is nearly a death sentence", since the case didn't begin as "advanced kidney cancer". The background 5-year survivability rates are shown as "66% for stage I renal carcinoma, 64% for stage II, 42% for stage III, and only 11% for stage IV."

The stages refered to are:

Stage 1 - Confined to the kidney

Stage 2 - Involvement of perinephric fat but Gerota's fascia intact

Stage 3 - Spread into renal vein

Stage 4 - Spread into adjacent or distant organs

I agree that turning down the bone marrow treatment would have happened anywhere, insurance or no insurance, but the criticism of the case is that all earlier applications for drug treatment had also been rejected and that's certainly not the case with other providers of medical care. Reading the Statement by Julie Pierce before the US House of Representatives, June 20, 2007:Drug after drug, treatment after treatment that our doctor sought for him was denied. Despite the fact that our doctor provided detailed scientific evidence for these treatment options, our insurer deemed them not medically necessary or experimental.The reason matters degenerated to a last-ditch suggestion of a bone marrow transpant is the rejections of earlier applications for treatment when the survivability rates were far higher.

[Uncle Fester]

It is when I read articles like this , I am so glad that I live in the UK , Pat's treatment is very expensive but it is free to us

[Patsy Warnick]

I have my own health care nightmares

I've had 15 surgeries since 1995 - I know my body, but yet still fight with procedures and health care provider.

I finally had some tests done @ 1 ago - tests results showed I had a cyst on my ovary. I said well we have a problem here?? DR said whats that - I don't have any ovarys. My film were re-read (which I had to pay out of pocket) - your right no ovarys exist - I was told this cyst will just dissolve.. NOT

So, for the last year I've felt this cyst growing - been trying to convince DRs & my insurance for a MRI, finally had a MRI a few weeks ago and my follow up appt. is today. I know what the DR will say - I already know the look on his face, I already know the tests results. I've already called my surgeon for a appt..

One would think with my history, there would be no hesitation for approval for tests - instead I'm prescribed pills.

Health care in the US is inadequate - we should be embarassed.

Remember the issue of Health Care when voting..

Patsy

[spot]

Patsy Warnick;662848 wrote: Remember the issue of Health Care when voting..




Is there a preference as far as party goes, Patsy? Would one do better than the other in this area, as far as improving provision to you goes?

Is it the Representatives or the Senate or the Presidency which matters most?

[Patsy Warnick]

Spot

NO, I feel very frustrated with the health care in the United States so, a candidate running for Governor - Senator - President has to have say strength towards that issue for me to vote for them.

I feel it should be a very important issue for everyone.

My health situation knowing I have a internal problem - DR won't/can't order a MRI - I was sent to a Ortho specialist - I kept arguing with my Primary DR that my pain wasn't my spine - so I finally go to Ortho, knowing its a waste of my time, money - a test I didn't need (MRI) for him to tell me today its not my spine .

1st my Primary DR - didn't believe me & felt this was a process of elimination

The Insurance Co. does not allow a primary DR to order the MRI

Bureaucracy - and I'm the one in pain - nearly 2 years and I don't know any more than when I started.

Patsy