Yahoo! News reports that the impact on Medicare of the cost of cancer care is big -- and getting bigger.
Cancer treatment has advanced quite a bit in the last twenty years. Now, it's not just about chemotherapy and radiation. There are biologic therapies that target individual molecules or structures within cells, aromatase inhibitors that block the formation of estrogen, not to mention what I call the "drugs for the drugs" -- that is, drugs like antiemetics that treat side effects caused by cancer drugs themselves, which tend to be harsher than medications for, say, a migraine. People with cancer are living longer and living better. That's a great thing, right?
Well, that's how I want to feel about new developments in oncology. But when I hear that they're costing the government astronomical amounts of money -- and that those costs are only going to get bigger as even more therapies are developed and the population gets older (cancer is, after all, primarily a disease of the old) -- I cringe. That money is coming out of my wallet, without my consent.
In a free market, people with cancer would pay for their own treatment, perhaps saving for such an emergency (they don't have to, at the moment; Medicare will take care of it) or taking out a catastrophic insurance policy (again, they don't have to). Or they might rely on the voluntary charity of friends, family, or sympathetic strangers. Then cancer treatment could be paid for only by those who want to -- and we taxpayers wouldn't have to feel so ambivalent when great strides are made in conquering this very difficult disease.
Tuesday, June 10, 2008
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2 comments:
Hey Stella! Very interesting post.
I think there are multiple complex effects going on here that contradict each other. Our desire to see innovative solutions arise for such problems is great and they speak to our conviction that man, left alone to use his reason can solve many problems. At the same time, the fact that healthcare, especially healthcare targeted at old age (via Medicare) is government subsidized introduces all sorts of bizarre effects on the state and progress of innovation in the industry. That is, without the weight of cost-benefit setting the boundary, all sorts of innovations get developed that otherwise would be delayed while more important ones are worked on.
For instance, today we are developing the ability to use diagnostics and genomics to understand key differences among disease states and develop drugs targeted specifically for a single genetic variant of a disease. This is the so-called beginning of personallized medicine. But when you look at cancer as a target for these therapies, it's easy to see that given the cost to develop any single drug, the market that results from individualized medicine like that is far too small to justify the cost - unless the price is subsidized. I would argue that the only reason that personalized therapies are even starting to be considered in cancer therapy today is becuase of the fact that the subsidy exists, and artificially makes the demand exist. Once demand exists suppliers will try to flock to it and forgo other options that would be more lucrative were it not for the subsidy.
This is the problem with government subsidies, not that they don't lead to innovations but that they inherently lead to the wrong innovations at the wrong time. And that damage we can't see, is the innovation that was foregone by virtue of the fact that limited resources were redirected to work on the wrong things. And that is the reason why lasseiz faire is the only policy.
As a cancer survivor, I'd like nothing more than to see innovative therapies arise for cancer treatment, but not before the cost of development and delivery is such that I can effectively pay for it or the insurance policy that delivers it out of my own pocket voluntarily.
I do think that personalization of therapies would exist in some way in a free market, but perhaps not in the way that it is currently evolving. I think cancer therapy might perhaps more resemble the HIV/AIDS market, which, while subsidized by government drug-buying programs for the poor, is not quite as heavily funded by the government (because so many cancer patients are elderly and therefore fall under Medicare's purview). In HIV, there are almost 30 different drugs available, which doctors then mix and match for their patients based on efficacy, side effects, convenience, and patient preference. I suspect that in cancer, a certain number of drugs would be developed, and doctors would then continue the innovation on a smaller scale by fitting drug combinations to their patients' needs.
Thank you for your thoughtful comment, which has just about as much content as my original post! :) And congratulations on surviving cancer.
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