The Language of Health Care Rationing

The Food and Drug Administration (FDA) is moving to “de-label” Avastin, the late-stage cancer drug for breast cancer patients. If successful, the FDA would allow Medicare and private insurance to deny coverage for the drug – even for patients who have relied on the drug to live.

The FDA has denied that the cost of the drug played a role in their decision but the evidence is mounting that is not the case. During initial consideration of the decision an FDA advisor specifically cited the cost of the drug as the reason for revocation. The drug costs $80,000 a year and allowing Medicare to deny coverage for the cost would “reduce the cost of health care,” as President Obama has demanded.

The FDA and their supporters deny cost is the basis of the decision. George Soros’ Media Matters denounced the rationing claim proclaiming that the drug does not “does not significantly prolong life.”

Significantly? Is six months, the average time an Avastin patient gets in extended life, “significant”? Is one year? What about the cases of the “super responders,” the women like Erin Howarth, who have taken Avastin for years and credit the drug for saving their life?

We can expect Orwellian language from George Soros but unfortunately for cancer patients, the language used by the proponents of rationing is the same as the bureaucrats justifying rationing. Terms like “significant benefit,” and “sufficient benefit” are the rationer’s lexicon allowing bureaucrats use to limit access and choices for doctors and patients because of the cost of the treatment. In each case, decisions on life are justified on a “cost-benefit” analysis.

Patients in Great Britain have been subjected to rationing for generations. In Great Britain’s government-run health care system, treatments for patients are evaluated on the basis of cost. The Orwellian named government agency that regulates costs and denies treatments for patients is called “NICE” (National Institute for Health and Clinical Excellence), has set a general limit of about $49,000 on the cost of extending life for a year. If the treatment costs more and only gives patients on average 11 months of life, you are out of luck.

That is why NICE announced it would not pay for breast cancer patients to have access to Avastin. NICE’s chief executive said, “The evidence for the effectiveness of bevacizumab in prolonging survival was not robust and overall did not show enough of a demonstrable benefit for it to be considered a cost-effective use of NHS resources.”

Without the British accent, these terms are now working their way into the American health care vocabulary.

BUREAUCRATIC CATCH PHRASE vs. PLAIN ENGLISH

“Significant” or “Sufficient”: Patient sees progress but not enough to justify the “cost-benefit” ratio set by the government.

“Outweigh the Risks”: Every drug has risks but this drug costs too much.

“Sufficient Benefits”: Once again, patient sees progress but not enough for our liking.

Cancer patient advocacy groups, unlike progressive think tanks, are protesting the FDA’s effort to move us toward a British health care model. Kim Thiboldeaux, the president and CEO of the Cancer Support Community, summed up the threat of the FDA’s actions when she the decision would have a “tremendous impact on reimbursement. We feel strongly that treatment decisions should be a joint decision between a women living with treatment and her treatment team…Limiting the already scarce range of treatment options for women with metastatic breast cancer would have a devastating impact.”