Insurance company deny treatment to 5 year old with Cancer

[Modbert]

And deprive resources from others who may be cured.

The pot is only so deep, regardless of who controls it.

It is what has been so maddening to me behind the Palin-esque rhetoric over this issue.

If anyone thinks their insurance company is going to foot every single bill for every conceivable treatment known to man, they are in for a shock.

What bothered me when I read this (other than the fact he was 5) was the fact the treatments had worked previously and they work now. So it's not like this is some random drug being used.

I think everyone understands the insurance companies cannot foot every single bill. However, there is room for major improvement on this.

 

[geauxtohell]

If you want to draw a line, then admit there is Health Care Rationing, simple as that. You seem to miss the fact that this is not some regular sort of cancer as well.

It's actually not that rare of a cancer. Per my understanding, it's one of the more common tumors in children.

 

[geauxtohell]

And deprive resources from others who may be cured.

The pot is only so deep, regardless of who controls it.

It is what has been so maddening to me behind the Palin-esque rhetoric over this issue.

If anyone thinks their insurance company is going to foot every single bill for every conceivable treatment known to man, they are in for a shock.

What bothered me when I read this (other than the fact he was 5) was the fact the treatments had worked previously and they work now. So it's not like this is some random drug being used.

I think everyone understands the insurance companies cannot foot every single bill. However, there is room for major improvement on this.

This is just a fraction of the larger fact that your healthcare is going to be rationed, regardless of where it comes from.

 

[Modbert]

This is just a fraction of the larger fact that your healthcare is going to be rationed, regardless of where it comes from.

Indeed. It's also very difficult to think that this is the best we can do. Because if this is the best we can do, then I just don't know.

 

[geauxtohell]

This is just a fraction of the larger fact that your healthcare is going to be rationed, regardless of where it comes from.

Indeed. It's also very difficult to think that this is the best we can do. Because if this is the best we can do, then I just don't know.

I suspect this issue is infinitely more complicated than "if we just give him this pill, he will be cured!".

Most things in medicine are.

 

[FireGod]

This is just a fraction of the larger fact that your healthcare is going to be rationed, regardless of where it comes from.

Indeed. It's also very difficult to think that this is the best we can do. Because if this is the best we can do, then I just don't know.

It is not the best that we can do, it is the best that we choose to do.

 

[Modbert]

I suspect this issue is infinitely more complicated than "if we just give him this pill, he will be cured!".

Most things in medicine are.

Well, of course. The article even says that. However, a fighting chance is a fighting chance. And the thing is, if we never use any experimental therapy or treatments, then we'll never really find out what works and what doesn't. Least that's how I look at it, I could be wrong though.

 

[geauxtohell]

I suspect this issue is infinitely more complicated than "if we just give him this pill, he will be cured!".

Most things in medicine are.

Well, of course. The article even says that. However, a fighting chance is a fighting chance. And the thing is, if we never use any experimental therapy or treatments, then we'll never really find out what works and what doesn't. Least that's how I look at it, I could be wrong though.

The current trend in medicine is for moving towards "evidence based medicine". That sounds silly, but in fact many things that are standards of care have not been properly evaluated and looked at to see if they really provide a benefit (pick up the latest time on SSRIs/anti-depressants for an interesting discussion on it). The idea is that treatment should be quantifiable.

This becomes a hard sell for experimental drugs. This drug could turn out to be the first line treatment for neuroblastomas in ten years, and this poor guy just had the bad luck that it wasn't discovered ten years ago.

Or it could turn out to provide, at best, a month or two to the lifespan of a patient with the cancer. At that point, it becomes a hard sell.

I agree with your larger point, I just wanted to toss a degree of pragmatism in here.

 

[xotoxi]

And deprive resources from others who may be cured.

The pot is only so deep, regardless of who controls it.

It is what has been so maddening to me behind the Palin-esque rhetoric over this issue.

If anyone thinks their insurance company is going to foot every single bill for every conceivable treatment known to man, they are in for a shock.

What bothered me when I read this (other than the fact he was 5) was the fact the treatments had worked previously and they work now. So it's not like this is some random drug being used.

I think everyone understands the insurance companies cannot foot every single bill. However, there is room for major improvement on this.

The major improvement is made when not only the EFFECTIVENESS of the THERAPY is considered, but the COST EFFECTIVENESS of the THERAPY is considered.

If the $100,000 treatment results in a 95% remission rate, but the remission only lasts 1 year, then the treatment is not cost effective, and the treatment should not exist.

But if the same treatment has a 95% cure rate with a resulting normal lifespan, then it is an adequate treatment.

At a lecture that I attended discussing this same information, I learned of a cancer treatment (I think it was Rituxan) for end stage colon cancer, which cost approx $50,000. It prolonged life expectancy from 6.5 weeks to 8.5 weeks. This is NOT a viable treatment to be considered in our healthcare system. (Unfortunately, I do not recall all of the specifics and I do not have a link).

The line has to be drawn.

 

[xotoxi]

I suspect this issue is infinitely more complicated than "if we just give him this pill, he will be cured!".

Most things in medicine are.

Well, of course. The article even says that. However, a fighting chance is a fighting chance. And the thing is, if we never use any experimental therapy or treatments, then we'll never really find out what works and what doesn't. Least that's how I look at it, I could be wrong though.

However, another way of looking at it is that if it is truly an "experimental drug", then the drug company should be giving it to the patient free of charge, as it is still in the research and development stages. It is a medical experiment.

 

[Avatar4321]

You expect an insurance company to pay $110,000 for two treatments??? And you wonder why the costs are skyrocketing?

What on earth about this procedure costs so much?

I feel for the family. But I think there comes a point where you have to be reasonable. I mean if you arent willing and able to pay for your son's treatment, why should anyone else?

 

[geauxtohell]

And deprive resources from others who may be cured.

The pot is only so deep, regardless of who controls it.

It is what has been so maddening to me behind the Palin-esque rhetoric over this issue.

If anyone thinks their insurance company is going to foot every single bill for every conceivable treatment known to man, they are in for a shock.

What bothered me when I read this (other than the fact he was 5) was the fact the treatments had worked previously and they work now. So it's not like this is some random drug being used.

I think everyone understands the insurance companies cannot foot every single bill. However, there is room for major improvement on this.

The major improvement is made when not only the EFFECTIVENESS of the THERAPY is considered, but the COST EFFECTIVENESS of the THERAPY is considered.

If the $100,000 treatment results in a 95% remission rate, but the remission only lasts 1 year, then the treatment is not cost effective, and the treatment should not exist.

But if the same treatment has a 95% cure rate with a resulting normal lifespan, then it is an adequate treatment.

At a lecture that I attended discussing this same information, I learned of a cancer treatment (I think it was Rituxan) for end stage colon cancer, which cost approx $50,000. It prolonged life expectancy from 6.5 weeks to 8.5 weeks. This is NOT a viable treatment to be considered in our healthcare system. (Unfortunately, I do not recall all of the specifics and I do not have a link).

The line has to be drawn.

Even more absurd when you consider that colon cancer is 100% preventable with proper and timely application of the butt-scope which, comparatively; costs pennies on the dollar. (Sorry, I wanted an opportunity to use the term "butt-scope").

 

[Modbert]

The major improvement is made when not only the EFFECTIVENESS of the THERAPY is considered, but the COST EFFECTIVENESS of the THERAPY is considered.

If the $100,000 treatment results in a 95% remission rate, but the remission only lasts 1 year, then the treatment is not cost effective, and the treatment should not exist.

But if the same treatment has a 95% cure rate with a resulting normal lifespan, then it is an adequate treatment.

At a lecture that I attended discussing this same information, I learned of a cancer treatment (I think it was Rituxan) for end stage colon cancer, which cost approx $50,000. It prolonged life expectancy from 6.5 weeks to 8.5 weeks. This is NOT a viable treatment to be considered in our healthcare system. (Unfortunately, I do not recall all of the specifics and I do not have a link).

The line has to be drawn.

That's understandable. I'm not saying the line shouldn't be drawn somewhere. I'm just saying that if major improvements can be made in our system then we should at least look into it.

What I find interesting with this article is that this is suppose to be the normal treatment for this sort of thing yet it's so expensive.

 

[Avatar4321]

I suspect this issue is infinitely more complicated than "if we just give him this pill, he will be cured!".

Most things in medicine are.

Well, of course. The article even says that. However, a fighting chance is a fighting chance. And the thing is, if we never use any experimental therapy or treatments, then we'll never really find out what works and what doesn't. Least that's how I look at it, I could be wrong though.

However, another way of looking at it is that if it is truly an "experimental drug", then the drug company should be giving it to the patient free of charge, as it is still in the research and development stages. It is a medical experiment.

I would think so as well.

 

[geauxtohell]

You expect an insurance company to pay $110,000 for two treatments??? And you wonder why the costs are skyrocketing?

What on earth about this procedure costs so much?

I feel for the family. But I think there comes a point where you have to be reasonable. I mean if you arent willing and able to pay for your son's treatment, why should anyone else?

How many people in this country can afford to pay $110,000 out of pocket for medical bills? You could easily rack up that amount with a hospital stay. If it were your child, would you think that their life wasn't worth that?

That's why people buy insurance with the reasonable expectation that their bills will be covered.

That's not the issue.

The issue is the cost versus the outcome.

 

[xotoxi]

The major improvement is made when not only the EFFECTIVENESS of the THERAPY is considered, but the COST EFFECTIVENESS of the THERAPY is considered.

If the $100,000 treatment results in a 95% remission rate, but the remission only lasts 1 year, then the treatment is not cost effective, and the treatment should not exist.

But if the same treatment has a 95% cure rate with a resulting normal lifespan, then it is an adequate treatment.

At a lecture that I attended discussing this same information, I learned of a cancer treatment (I think it was Rituxan) for end stage colon cancer, which cost approx $50,000. It prolonged life expectancy from 6.5 weeks to 8.5 weeks. This is NOT a viable treatment to be considered in our healthcare system. (Unfortunately, I do not recall all of the specifics and I do not have a link).

The line has to be drawn.

That's understandable. I'm not saying the line shouldn't be drawn somewhere. I'm just saying that if major improvements can be made in our system then we should at least look into it.

What I find interesting with this article is that this is suppose to be the normal treatment for this sort of thing yet it's so expensive.

The problem with drawing the line is that people will have a hissy fit...just like in the UK, where at a certain age, people with kidney failure are no longer eligible for a transplant.

That is where a line was drawn. It might seem arbitrary and cruel, but there are reasons for it.

In this country, we do not draw lines. There is a sense that everything should be done to keep us alive, no matter what the cost. Like the death panel thing. Like hospice. Like Living Wills.

The notion that discussing these options is condemning someone to death is the most insane ridiculous thing that I have ever heard. It makes me sick.

And because of this philosophy the dying is bad, we end up with exorbitant end of life costs...like this boy's costs.

 

[Si modo]

An insurance company doesn't cover a treatment that the federal government has deemed is experimental, and a treatment that is more than 50 times more expensive than a typical non-experimental treatment?

What is the gripe again?

 

[elvis]

An insurance company doesn't cover a treatment that the federal government has deemed is experimental, and a treatment that is more than 50 times more expensive than a typical non-experimental treatment?

What is the gripe again?

Here's my question, Modo. If we had the public option, would the GOVERNMENT cove such an experimental treatment?

 

[xotoxi]

You expect an insurance company to pay $110,000 for two treatments??? And you wonder why the costs are skyrocketing?

What on earth about this procedure costs so much?

I feel for the family. But I think there comes a point where you have to be reasonable. I mean if you arent willing and able to pay for your son's treatment, why should anyone else?

How many people in this country can afford to pay $110,000 out of pocket for medical bills? You could easily rack up that amount with a hospital stay. If it were your child, would you think that their life wasn't worth that?

That's why people buy insurance with the reasonable expectation that their bills will be covered.

That's not the issue.

The issue is the cost versus the outcome.

Everyone thinks that their loved ones are priceless and that a price cannot be placed on a life. But, in actuality it can, and it should.

The unfortunate thing is seen in this case...the final treatment for this child is located just behind an impenetrable glass wall. It exists, but he is not eligible for it due to cost.

It would be better if the treatment did not exist at all. Then, he and his family would be able to eventually come to terms with the inevitable.

These crazy experimental treatments are giving people false hope.

 

[Modbert]

The problem with drawing the line is that people will have a hissy fit...just like in the UK, where at a certain age, people with kidney failure are no longer eligible for a transplant.

That is where a line was drawn. It might seem arbitrary and cruel, but there are reasons for it.

In this country, we do not draw lines. There is a sense that everything should be done to keep us alive, no matter what the cost. Like the death panel thing. Like hospice. Like Living Wills.

The notion that discussing these options is condemning someone to death is the most insane ridiculous thing that I have ever heard. It makes me sick.

And because of this philosophy the dying is bad, we end up with exorbitant end of life costs...like this boy's costs.

Alas, it always comes down to people.

I mean I don't see Hospices or Living Wills as bad things.

But let me ask you something about something you said earlier.

Shouldn't they be giving this boy the drug for free if what you say is true? Not the insurance company but the other party involved here.