Budgeting Cancer Drugs? Hmmmm.


Like many Americans, I find myself torn on aspects of health care reform as it relates to the insurance industry. I spend a lot of my time writing about insurance and frankly, I have a lot of issues with the whole concept. Like many things in life, however, insurance has become one of those things with which you have to deal on some level. I can’t drive my car without being insured — well, I could — but I’m not into fines and losing my license. I am, however, very ambivalent and by turns annoyed at the prospect of being compelled to carry health insurance and I’m concerned about some of the ways the industry is responding to new regulations by adopting cost cutting measures.

When I read that a number or large insurers, Aetna and UnitedHealthcare among them, are working with oncologists to encourage the use of “standard” treatments over individualized programs, my hackles go up a little. Now granted, cancer therapy is a huge burden on the health care system in this country — about $100 billion a year, with an average patient on chemotherapy facing annual bills of $100,000. In a different way, I’ve waged a battle with cancer over a 25-month period with a beloved pet. I went to the bank and borrowed money for his radiation treatments. He’s been gone 14 months and I haven’t paid off all his vet bills yet. Times that by a factor of 100 and you have what a family facing the illness of a loved one deals with.

And it is true that oncologists essentially sell drugs and that they can make an enormous profit. Some estimates suggest that as much as half of a typical oncologists income derives from the difference in what they pay for drugs and what they charge their patient’s insurance programs. But if I’m sick or my loved one is sick, I don’t want my doctor being guided by what the insurance company will and won’t pay for. The human body is a marvelously unique organism. The key word being unique. We don’t all respond in the same way to the same drugs. They can cite all the studies they want to saying use of “standard protocols” saves money with no effect on the patient. I don’t believe them. Period.

File this one away in your “things to ask if” folder. Either way, I sniff profit potential. Oncologists either get paid to use a lot of drugs or they get paid to use fewer drugs, but they’re getting paid all the same. I want doctors concentrating on one pay off and one pay off only — treatments that work.

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