Patient choice looks to be the first casualty of Obamacare.
The new healthcare law gives the federal government unprecedented control over medical decisions. And one bureaucrat in particular looks to be leading the crusade for more public power: Dr. Donald Berwick, the new director of the Centers for Medicare and Medicaid Services (CMS). CMS may be obscure. But it wields enormous influence over the availability of treatments. If CMS decides a treatment isn’t worth its price, public insurance programs like Medicare and Medicaid will stop covering it, and patients will lose access to the treatment.
Berwick is an ardent supporter of rationing. As he said last year, “the decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open.”
This troubling philosophy has been on full display during the government’s recent consideration of Avastin, the cutting-edge cancer drug.
Breast cancer patients have relied on Avastin for many years. For millions of women, the drug has slowed or stopped the progression of disease and improved quality of life. But this year, an FDA advisory panel recommended that Avastin be stripped of its FDA approval for use in breast cancer treatment.
The panel concluded that the drug, which will remain approved to treat other cancers, wasn’t showing enough promise against breast cancer.
But we know that in the manufacturer’s crucial phase III trial, nearly 50 percent of patients receiving the medicine saw their tumors shrink– and that for some patients, Avastin has added years of life.
Two major cancer-fighting organizations think that’s enough. Susan G. Komen for the Cure and the Ovarian Cancer National Alliance sent a
letter to the FDA, urging the agency not to revoke approval. They argued that choosing a treatment should be left up to patients and doctors — not taken off the table by a government agency.
So what’s really going on? There’s speculation that another factor was involved — namely, money. One year of Avastin treatment costs roughly
If the FDA accepts the panel’s recommendations, Avastin would only be available as an “off label” prescription to breast cancer patients.
This could mean that Medicare would stop covering the drug. Enrollees suffering from breast cancer would have to use alternative treatments– even if they’re less effective.
Instructively, public officials have taken the opposite position on Avastin when it comes to treatment for macular degeneration — a condition that causes vision deterioration mainly for the elderly. The drug is widely used as an off-label treatment for the disease. And it’s relatively cheap in this case, costing just about $50 for treatment.
The other major drug for macular degeneration is Lucentis. It’s scientifically related to Avastin — and produced by the same company– but more expensive. It costs about $2,500 for a full treatment.
The price difference between Avastin and Lucentis could soon result in public officials actively pushing patients to use the latter. Right now, the National Institutes of Health is conducting a massive study comparing the safety and effectiveness of Avastin against Lucentis for the treatment of macular degeneration. The results will likely be used to justify clamping down on public coverage for Lucentis.
Again, patients will suffer. Avastin may well work for most of them. But the human body is tremendously complex. Some patients respond better to Avastin; others respond better to Lucentis. But, if the government has its way, they’ll lose the more expensive option.
America’s health system appears to be on the fast-track to British-style rationing. Indeed, CMS Chief Administrator Berwick has publicly professed his admiration for the British government’s National Health Service and its approach to health care.
In the U.K, Avastin is already withheld from breast cancer patients. The policy has taken a huge toll on human life. While American breast cancer patients have a five-year survival rate of 84 percent, their British peers have a rate of just 69 percent, according to a 2008 report in the Lancet, the prestigious medical journal.
If the Obama administration has its way, government bureaucrats could impose policies that push U.S. survival rates closer to the British ones.
We can’t let this happen. Policymakers need to fight to preserve patient choice. If not, government rationing will become the law of the land, and Americans will be deprived of vital medical options.