> universal healthcare for fighting cancer seems like trying to stop a fire with gasoline
Tell that to the unemployed dad whom, twenty minutes ago, I directed to take his son to the ENT. He has had a swollen left tonsil for 5 years (last time he saw his pediatrician). Now he presents with 1 day of left ear pain. There's a mass hanging off his ear drum. Cholesteatoma? Unlikely. Maybe bullous myringitis. But at this point this kid's whole left pharynx is suspect and 5 years of infection starts one thinking about scary things.
And how will people understand that some cancers should be convered while others shouldn't? (especially if they have the "other" cancers)
Add to the mix a difference of incidence based on ethnicity and people will want universal converage of all cancers regardless how useful or useless treatment may be.
> And how will people understand that some cancers should be convered while others shouldn't?
I don't understand the question. All cancers are covered. If a cancer is treatable then it is treated. If there's no hope than palliative care is provided. If it's in the quite wide margin then the patient and the doctor talk about current best practice, and decide based on what the patient wants.
If you're asking about how the people paying the bills decide what treatments can be funded and what treatments should not be funded, well, you develop a measure. That measure is something like "years of quality life" - Quality of Life Years is used in bit of English planning.
You have an independent body assessing evidence of effectiveness, vs cost. If something provides X QoLYs it gets permission for funding; if it doesn't the patient can fund it themselves.[1]
They then publish their documentation, and it gets reviewed every few years.
That's a transparent process, allowing people to review and challenge the choices made.
This can lead to some odd decisions. Treatment for some forms of age-related macular degeneration used to be limited to one eye, because being blinded is bad, but being blinded in one eye is not as bad. That decision was later changed.
Alongside that you tell people to stop smoking, and you offer them free smoking cessation services; you have strong H&S COSHH laws, and you enforce them; you educate about the dangers of too much sun[2]; etc etc.
[1] The UK had an unfortunate situation where drug companies were creating cancer treatment drugs that would provide maybe 30 days of extra life at a cost of tens of thousand of pounds. They then set up and funded patient advocacy groups who would call for the drugs to be funded on the NHS. Providing information to those groups was an effective way to bypass the strict laws against marketing to the public. The weird choice the government at the time made was to change a law so that if someone wanted to "top up" their treatment with one of these expensive but useless meds that person would have to fund all their treatment, not just the cost of those extra meds.
[2] Vitamin D is very important, and helps avoid some cancers. You only need a bit of bright sunshine (or better diet) to get it - sun bathing for hours everyday with no sun-screen is too much.
I can't comment of the UK system, I haven't had any experience with it (theoretical experience is not the same as the actual experience)
QALYs and DALYs have a potential - they are interesting tools to separate covered cancer from uncovered cancers, but I would fear political abuse and biased measurements - just like your [1] example.
The PBS (an independent government organization, which is walled off from political lobbying) will subsidize drugs, but only ones which are worth it (as decided by expert panels). They act as a monopoly buyer, forcing monopoly sellers (the drug companies) to offer a more reasonable deal. If the drug is too expensive, the PBS won't subsidize it, and the drug company can lower the price (to get PBS subsidies) or face drastically lower sales.
I don't get what is being discussed here. How is universal healthcare like fuel to a fire where cancer is concerned?
I live in a country with universal care, so my perceptions will obviously differ to others, but I'm totally not getting what is being discussed.
In the USA, universal care is seen as a silver bullet by many who have never dealt with the reality of what it would bring. To a lot of people who support it, it's a vague undefined concept onto which they are projecting a lot of things out of their own imaginations, hopes, and fears.
Depending on the implementation, "universal health care" could make some things better than they are under the present system. Some things would be worse. People will still get sick. People will still die. People will still avoid seeking treatment until their condition is untreatable, because people avoid doctors and hospitals for a lot of reasons besides monetary cost.
A big part of the problem in the original article is that of TOO MUCH CARE being provided regardless of cost without much consideration for whether the care is worth providing. One plausible concern about adopting "universal care" in the US is that it will make a bad situation worse, even further insulating patients from the cost of the care provided to them and thus making it more likely that we waste effort on extremely expensive procedures that don't do any good.
Now, certainly one might IMAGINE putting rules in place such that this didn't happen, but that doesn't mean such rules will get put in place or will actually work as intended given our generally messed-up political process.
> Now, certainly one might IMAGINE putting rules in
> place such that this didn't happen, but that doesn't
> mean such rules will get put in place or will
> actually work as intended given our generally
> messed-up political process.
Isn't the assumption that universal health care will have no rules just as based in speculation as the idea that it will?
'Universal health care' is a pretty broad term. Most discussions that aren't about particular implementations are meaningless.
>Isn't the assumption that universal health care will have no rules just as based in speculation as the idea that it will?
The problem is what's acceptable in terms of denying care is very dependent on culture. In the UK people accept that the NHS doesn't pay for a heart transplant when the patient is 80 years old. In the US people expect every intervention to be provided (if the patient wishes) up to the moment that person dies. Universal care isn't going to change that attitude, at least not for a generation or two.
The most likely outcome of universal care in the US is a two-tiered system, where the national system pays for some subset of the things that can be done, and people buy private insurance to cover what they're used to getting now.
That's what the UK has - there is the NHS for everyone, free at the point of delivery, and there is a smaller private health care sector where you can get anything you can pay for.
No, I'm sure it'll have rules intended to control costs and reduce unneeded care, but our regulatory history suggests the rules won't work as advertised. And that doesn't seem speculative at all - it's a dead certainty. Because the problem we have is NOT that individuals pay for health care, it's that health care is ludicrously expensive and ineffective and over-regulated and not subject to significant market competition on price or quality. Merely changing who writes the checks won't fix the other stuff which is the core of the problem.
In every other field, new technology makes production of goods cheaper. Even in medicine, if you look at the parts where people pay without insurance - LASIK, plastic surgery, dentistry, veterinary medicine - costs get cheaper over time. The parts of medicine that tend to get ever more expensive are the parts that involve third-party payment.
The book _Priceless_ has some decent suggestions for mechanisms that might help improve matters even given the existing (terrible) constraints we face.
> The parts of medicine that tend to get ever more expensive are the parts that involve third-party payment.
Medicine has a problem with third party payments that are invisible to consumers, coupled with insurance premiums invisibly negotiated by employers, coupled with ridiculous regulations that have created an enormous amount of dislocation of the economic incentives that would tend to drive prices down. In short, government got involved. What's our national solution? More government involvement.
See any similarities between health insurance, retirement planning (Social Security), "free" healthcare (Medicare & Medicaid), student loan programs and the cost of college education, or maybe in the home loans that caused the housing disaster?
Disaster after disaster is caused by applying heavy-handed Federal Government "solutions" to problems better solved by individuals, free markets, or at worst local and state governments.
Since there's already Medicaid for the poor and no hospitals deny care now... your statement would appear to be incorrect.
I don't mind funding a worst-case-scenario safety net for the most vulnerable in the society. I don't mind some serious legislation aimed at fixing the real problems with healthcare in this country. The law passed by the Democrats in 2009 was a useless counterproductive disaster.
I work at an urgent care. We routinely turn away people who are uninsured or have Medi-Cal (California medicaid) AND are unwilling to an upfront fee for the evaluation. So we see the uninsured but only if they pay. I see no difference in the chief complaints, but the uninsured generally wait quite a bit longer, and therefore often need not 5 times as much care, but 100 times as much.
The topic of universal health care is actively debated in the US. Some people have adopted a position that universal health care is less ideal than our current fee-for-service model. As they explore the merits of their position, they try adopting various arguments. He tried adopting the argument that universal healthcare leads to more access to care, which leads to more interventions between diagnosis and death for people with cancer. However, and perhaps our responses help persuade him of this, that argument ignores the vast middle ground of people who survive several years or even are effectively cured for life. It also, as my prior comment pointed out, ignores the value of routine screening, especially at the extremes of age.
Tell that to the unemployed dad whom, twenty minutes ago, I directed to take his son to the ENT. He has had a swollen left tonsil for 5 years (last time he saw his pediatrician). Now he presents with 1 day of left ear pain. There's a mass hanging off his ear drum. Cholesteatoma? Unlikely. Maybe bullous myringitis. But at this point this kid's whole left pharynx is suspect and 5 years of infection starts one thinking about scary things.