Category Archives: General Cynicism

American exceptionalism, not so good:

Health spending is rising faster than incomes in most developed countries, which raises questions about how countries will pay for their future health care needs. The issue is particularly acute in the United States, which not only spends much more per capita on health care, but also has had one of the highest spending growth rates. Both public and private health expenditures are growing at rates which outpace comparable countries. Despite this higher level of spending, the United States does not achieve better outcomes on many important health measures. This paper uses information from the Organisation for Economic Co-operation and Development (OECD)[1] to compare the level and growth rate of health care spending in the United States to those of other OECD countries. (Medicynical emphasis)

Medicynical Note:  Spending more, no better outcomes.  Inefficient, poor value for the dollar, average quality, 50,000,000 plus uninsured.

Best in the world, or just the most expensive?

15 years ago my wife needed a stem cell transplant and was treated at Swedish Hospital in Seattle. At the time we had great difficulty getting our health insurance to cover the cost of treatment. On the same hospital floor was a man with testicular cancer, guarded by police from our local jail,  having  his transplant.

Times haven’t changed!

Convicted rapist Kenneth Pike, of Auburn, N.Y., is expected to undergo a life-saving heart transplant that could cost up to $800,000 — a price that will be paid courtesy of New York state taxpayers.

Medicynical Note: I don’t object to providing anyone access to healthcare. It’s a humane approach to our fellow humans. Others seem to think it’s somehow the patient’s fault that he/she is sick and, regardless of their insurance or financial status, that they must bear the burden of their care or do without.

Is that the new American way?

Incomes have declined in the past 10 years (see below for 25 years data). The median income of families is now just under $50,000/year. That means half of American families live on less than $50,000 and the great majority on not much more than that. This from the Daily Kos.

Yet Ryan in his budget proposal wants to balance the budget by increasing taxes on this group (those with incomes under $50,000) while decreasing taxes on those whose incomes and wealth have increased dramatically in this era (incomes over $125,000)

Medicynical Note: It’s enough to make a medicynic cynical.

The good news is that there  may be a drug that improves, somewhat, the survival of patients with malignant melanoma.

The bad news is that the drug company marketing the drug, Bristol Meyers,  is charging $120,000 for a course of treatment, four injections over three months.

In that randomized clinical trial, patients with metastatic melanoma treated with Yervoy lived a median of about 10 months, compared with 6.4 months for patients in a control group, who received a treatment believed to have had little effect.

And:

More than 20 percent of the people who received Yervoy in the trial lived at least two years, and some of them much longer. But there is no way at present to predict which patients will benefit from the drug.

But, always a but:

The drawback is that loosening the restraints on the immune system can lead to dangerous side effects, the most worrisome being colitis and diarrhea, but also hepatitis, endocrine dysfunction and skin problems. The F.D.A. said that 12.9 percent of patients treated with Yervoy suffered severe or fatal autoimmune reactions.

Medicynical Note:  The drug in this early study appears to have some efficacy and significant toxicity. Half the patients treated get less than a 4 month survival benefit–if this study’s finding hold up in the future.  (It should be noted that  first studies often show better results than confirmatory studies)

Can our non-system of care afford a $120,000 drug that improves survival just 4 months?  Can 99% of our citizens afford such a drug if insurance doesn’t cover.

The pharmaceutical industry deserves credit for helping develop an  drug with some efficacy.  But charging 3-4 times the average person’s income/year, takes the pay us or die ethic to a new extreme.

The question is not whether we will ration care by cost to most people but how.  It should be understood that whatever the approach we take,  republican or democratic, the wealthy will be more able to afford that which is not covered by insurance. 

We may have the opportunity in future elections to decide.