So who cares about health costs?

“When I’m with a patient, my job is to be a patient advocate, not to try to save society money on chemotherapy,” said Dr. Barbara L. McAneny, the chief executive of New Mexico Oncology/Hematology Consultants, in Albuquerque.

The quote was in reference to a new drug, Abraxane developed by Abraxis. The manufacturer”s spokeman “Dr. Michael Hawkins made a remarkable observation about how the company’s $4,200-a-dose drug compared with $150 generic paclitaxel.”

“Dr. Hawkins said the F.D.A. should approve Abraxane in early-stage patients without a clinical trial because such testing would probably not prove that his company’s drug was different than the conventional treatment. “These are just two forms of paclitaxel,” he said.” Yet one costs $4200/dose the other $150.

Our non system of health care is fatally flawed by the lack of a mechanism of cost containment. All levels of the system have conflicts of interest that interfere with unbiased cost effectiveness evaluations. The above article notes that patients with insurance have few incentives to be cost conscious. As also noted, physicians many with inherent financial conflicts of interest, do not accept responsibility for more rational choices. Manufacturers obviously aren’t interested in controlling costs of health care–their fiduciary responsibility is to maximize profits. Insurers have tried but their focus has become guarding their own profits and passing through costs. Government’s interest in cost containment has been nullified by the contributions of special interest lobbies.

So who cares about costs?