Tuesday, February 24, 2009

Another National Health Insurance Hit Piece

This time it's an article in The Atlantic in which a breast cancer survivor talks about how the drug that she hopes has eliminated her cancer would not have been covered in New Zealand. The basic thrust of the article is that the author—Virginia Postrel—survived as a consequence of spending $60,000 on a drug called Herceptin, which is very effective for certain cancers when taken early; she claims that if she had not had access to the American health care system, she would have died or been bankrupted. She justifies this by saying that the treatment protocol she followed was not covered in New Zealand or the U.K. until recently.

There are a number of problems with this. The first is that when the New Zealand health authorities decided not to fund the $60,000 one-year Herceptin treatment, there was massive and effective national protest, and as a consequence of this, they began funding it. So in fact New Zealand does now fund the full one-year Herceptin treatment. In the U.K., the government bypassed the standard evaluation process to make sure that the treatment was available, because it was such a highly-charged political issue.

Nevertheless, Ms. Postrel claims in her article that the U.S. system is better, because her treatment was covered. She fails to point out that here in the U.S., unless you happen to have health insurance, which a large minority of Americans do not, you can't possibly afford the Herceptin treatment. So, to paraphrase what she says at the beginning of the article, if she were one of those Americans, she would probably be dead.

She also fails to point out that even insured Americans face varying standards of practice. Breast cancer is not something you anticipate—it is a surprise. It becomes an urgent thing when you are diagnosed. Before that, you may check carefully to see if the cancer treatments you might need are covered by your current insurance, or you may not. You may guess right, or you may not. You may have the choice of an insurance policy that covers early Herceptin treatments, or you may not. Whether or not you have coverage for this particular treatment is a crap shoot—it is by no means certain.

So the fact that her particular insurance policy covered Herceptin should not be taken by Americans who are fortunate enough to have health insurance as an indication that they too would be covered in the event that they get the same kind of cancer. No, they had better check their own policies carefully.

She goes on to talk about the fact that kidney cancer, which affects many fewer patients, has four competing treatments, none of which is clearly preferable. She points out that in the U.K., unless you happen to be paying for private "topping up" coverage, you will not be able to try all four treatments. Of course, she again fails to mention that here in the U.S., unless you can afford private insurance, you definitely won't be able to try any treatments, nor will you be able to be treated for any other disease you may get that is covered by the National Health Service in the U.K.

So yes, if you happen to have the bad luck to get kidney cancer, you are worse off in the U.K. than you are in the U.S., if you happen to have a policy that has the kind of generous coverage she assumes all U.S. insurance policies have. But in general you are probably better off, because if you can afford "top up" coverage, you can get whatever treatment you need, and if you can't, you are still covered for the majority of different kinds of bad luck you might experience, including at least some treatment for your kidney cancer. Here in the U.S., there's a good chance that you have no coverage at all. Of course if you are a person who does have coverage, the U.S. system may seem preferable, if you happen to get kidney cancer, and if the treatment you need happens to be covered by your particular insurance policy.

She set out to prove that national health care is a bad thing, because some expensive drugs aren't covered. She actually proved the opposite. The health care systems she criticizes are doing the right thing, by her own definition. They are doing it precisely because the public has a say in what is covered and what is not.

She implies that competition between health insurance providers in the U.S. means that her drug is covered, but fails to point out that except for high-profile drugs, no such competition exists, because we choose our health insurance before we get sick. We can't anticipate which drugs we will need. So we can't check to see if they are covered.

Things didn't turn out well for her because she is an American. They turned out well for her because she is a very fortunate American.

2 Comments:

Anonymous Patricia said...

I think you've hit all the salient points.

Wednesday, February 25, 2009 9:12:00 PM  
Blogger Emma Bull said...

Bravo! Excellent article, excellent rebuttal to this often-repeated misconception.

Thursday, February 26, 2009 12:32:00 AM  

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