Health Wonk Review: Oncologists Tell the Truth about Cancer Drugs; Will There Be Enough Plans to Choose From in the Exchanges? What Does Oregon’s Research on Medicaid Tell Us? And More . . .

The newest edition of Health Wonk Review  is up on Managed Care Matters.

There, host Joe Paduda calls attention to an eye-opening post by The Health Business Group’s David E. Williams. 

Williams reports on what oncologists say about cancer drugs in “The Price of Drugs for Chronic Myeloid Leukemia (CML); A Reflection of the Unsustainable Prices of Cancer Drug.” The article, which was published in the journal, blood, includes candid comments from more than 100 experts  They tell us  that:.

  • Many costly treatments aren’t worth the money
  • New treatments with tiny orno benefits often cost a multiple of existing therapies
  • Despite their reputation for penny-pinching, health plans are often not aggressive in negotiating price
  • Patients are already suffering mightily from high costs –and it impacts quality of life and survival as well as financial health
  • Society as a whole cannot afford to pay the high prices charged for so many of the new therapies

 (I’m reminded of “A Very Open Letter from an Oncologist published on HealthBeat in 2009.)  It’s encouraging to see more oncologist stepping forward to telll the truth about cancer drugs..)

.As Williams observes these insights “come from people who know what they’re talking about and who have traditionally been sympathetic to drug makers and unperturbed about costs.”  

But now, the companies that make these drugs have taken greed too far.

 Paduda also highlights Health Affairs just-released research indicating that the decline in inflation could result in a reduction of $770 billion (yup, that’s “billion” with a B) in public program health care costs over ten years. “

But is the trend sustainable? John Holahan and Stacy McMorrow of the Urban Institute are “cautiously optimistic.” Paduda agrees: “there’s no question there are fundamental changes occurring that are affecting care delivery, pricing, and reimbursement.”

Posting on Health Affairs Blog, John Roehring is less optimistic. His in-depth analysis of health care spending and economic cycles is rigorous. But is it relevant?
Something extraordinary has happened in the past few years: The U.S. finally has passed health reform legislation that aims to provide universal access to high quality care. The legislation recognizes that in order to do this, we Must bring down costs.
Passage of the legislation was all but inevitable. 

After years of over-spending, we were heading for a wall. Healthcare spending cannot swallow 25% of GDP. And what can’t happen, won’t. We must become more efficient. 

Thus, the past may not tell us much how health care spending will respond to an economic recovery this time around. The Affordable Care Act marks a turning point—and there is no going back. We are in a truly different era.

Roehring is not as hopeful as I am, but he acknowledges that “Some portion of the slowdown is permanent but some will be given back during a recovery”.

Over at The Hospital Leader, Dr. Brad Flansbum writes a provocative post about “Successful Home Management and the Hospital Bottom Line”:

“Care management done right and transitions executed properly keep folks out of hospitals and reduce profits,” he observes. ”If HQP gives a glimpse of the future, the exponential growth of our field will flatten, if not fall.”

In other words: “We receive our salary from the beast we wish to slay. Sucks for us and I cannot help but think of Upton Sinclair’s quote:
‘It is difficult to get a man to understand something, when his salary depends upon his not understanding it!’”

That may be, but these days, more and more physicians are deciding that in the battle over healthcare they would rather be Knights than Knaves or Pawns. (Hat tip to the National Physicians’ Alliance for coming up with these categories.

Signs of the times: Oncologists are telling us that many of our priciest cancer drugs aren’t worth the money. Urologists are no longer recommending PSA testing.
Increasingly, these physicians are looking past their salaries, and asking: “What would be best—not for the hospitals, not for the doctors– but for the patients?”

“Being in a hospital” clearly is not the answer.

This brings us to the question of reducing readmissions.  Paduda notes that in response to “a recent WSJ opinion piece assaulting Medicare’s new hospital re-admissions reimbursement policy; the John Hartford Foundations’ Chris Langston presents a clear-eyed, point-by-point rebuttal that shows why the program is a necessary and important step to improving health for older adults.”  I would add that, as Langston points out, hospitals will not be penalized for readmitting some patients.  The penalty applies only if Medicare sees a pattern showing an unusual number of patients bouncing back into hospital beds. .

Over at Health News Review, Gary Schwitzer highlights an innovative way to market a product to doctors that involves Hooters. I don’t spoil the surprise—just go to Paduda’s Health Wonk Review, and click on the link to Schwitzer’s story.

Will there be a “train wreck” in Colorado when the state opens its Exchanges? Louise Norris of Colorado Health Insurance says “No.” They’re ready—and they’re not alone.\
Will there be enough insurance products available in the Exchanges to give consumers choices ? Writing on Wendell Potter says there will be plenty. In a few months, we’re likely to be complaining about how hard it is to compare so many plans. Moreover, the notion that you need a dozen companies competing to keep prices down is a myth. In Vermont, he points out, just two companies vying for Exchange business, and premiums are not going up.

How much do you think UnitedHealth’s CEO earns? On Health Care Renewal, Roy Poses will tell you. Brace yourself.
Recently, the state of Oregon compared the the health of citizens who made the cut for the state’s Medicaid program, to those who didn’t. (They qualified, but there were not enough spaces.)
The comparison revealed that, after two years on Medicaid, patients in the program had not made much progress in lowering blood pressure or cholesterol. Diagnosis of diabetes went way up, and the use of medicine to control diabetes also went up, but, again, there wasn’t much difference on the relevant blood tests

John Goodman sees this as damning indictment of Obamacare; “a new study finds that (as far as physical health is concerned) there is no difference between being in Medicaid and being uninsured.”

By contrast,Health Wonk’s  Ezra Klein points out that depression rates for patients on Medicaid fell by 30%. This is huge. If you think about the damage that depression does to our bodies and our minds—as well as the links between depression, smoking, drug abuse and alcoholism—these patients were clearly better off. My guess is that they no longer felt as isolated as they had in the past. They had someone to talk to. (To learn more about the connection between poverty, loneliness and poor health, see this briliant PBS documentary, “Unnatural Causes.”

At the very least, their diabetes had been diagnosed, making it much less likely that they would go blind, or face amputations down the road. (If this isn’t good enough for Goodman . . .)

Finally, here’s my take on what the study showed:

1) People on Medicaid are poor.

2)There is a limit to what healthcare can do for people who have been born into poverty and have been poor for most of their lives.

The stresses and deprivations of poverty take an enormous toll. As Dr. Steven Schroeder pointed out in a landmark Shattuck lecture in 2007: “When compared to poverty, medical care plays “a relatively minor role” in premature deaths.” Scroll down to the pie chart in his article, and you’ll see what he is talking about.

I’m not at all surprised that after two years on Medicaid, complicated problems like hypertension and high cholesterol had not been resolved. They still may die sooner than many of us, but clearly the quality of their lives has improved.

Note– This was a rich edition of Health Wonk Review, and these are just highlights. I would urge you to read the whole post.

6 thoughts on “Health Wonk Review: Oncologists Tell the Truth about Cancer Drugs; Will There Be Enough Plans to Choose From in the Exchanges? What Does Oregon’s Research on Medicaid Tell Us? And More . . .

  1. Thanks for the note about the David Williams article on overpriced cancer treatments.

    Americans have had the luxury to spend unlimited amounts per patient. This is a by product of having multiple payers — i.e. Medicare does not worry if a private payer gets stuck with a huge bill, and the private payers are delighted to stick Medicare or Medicaid with huge bills.

    In a single payer system, one cannot avoid the fact that spending $300,000 on keeping one person alive for six months will reduce the funds for home care visits and nursing home care and hip replacements.

    This is why the British in many cases just refuse to pay for super-expensive drugs. It comes down to the greatest good for the greatest number. America has been the place where those near death could carry on the most expensive fights against death — and that may change.

    One other small note — and this is an old preoccupation of mine — the $770 billion reduction that Cutler refers to is not what an ordinary person would call a reduction in spending.

    Instead it is Washington-speak for a reduction in projected spending.

    What he is saying is that instead of Medicare and Medicaid costing $1.5 trillion a year in 2022, maybe they will cost $1.427 trillion a year, or $77 billion less.

    I am not too comforted.

    • Bob–

      What is important is not the aboslute number of dollars spent on healthcare but whether healthcare spending is
      growing as a precentage of GDP.

      If we can keep it flat as a % of GDP—or down 2 or 3 % we can afford high quality care for everyone—and
      Medicare will be sustainable.

  2. Good point but I would raise one caution.

    The GDP does not pay taxes.

    That sounds kind of snarky and clever, but what I mean is this:

    Medicare and Medicaid have to be covered out of federal revenues.

    If the GDP grows but federal revenue does not grow, then health care has big problems.

    Per David Cay Johnston, the GDP did grow from 2000 to 2010 but tax revenues were stone flat. The govt collected $2 trillion in 2000 and collected $2 trillion in 2010.

    I know there are complex reasons, but I still resist measuring health care by GDP.
    I like Jeffrey Sachs but he does this all the time and I am cautious.

    • Bob–

      If GDP grows and federal revenues do not grow this is becuase we are not taxing those who are profiting from GDP growth–corporations and wealthy individuals (shareholders).

      In the U.S. tax rates for corporations and the very rich are much lower than in other developed countries. (Here I am talking about all taxes, not just income taxes, but Inheritance taxes, VATS, sales taxes, etc. etc. )

      It’s worth noting that relatively few Europeans (including doctors and other talented, well-educated Euopreans) are clamoring to immigrate to this country.
      They would perfer to live in a place where they pay higher taxes, but safety nets are in place,
      everyone has good heatlhcare, and education is valued.

    • Thanks Greg.

      It’s one of my favorite posts.

      Have you read Clifton Leaf’s new book on cancer? (please e-mail me)