The Traps Of Universal Healthcare

The New York Times writes about a cancer patient in the British Health Care System:

Debbie Hirst’s…breast cancer had metastasized, and the health service would not provide her with Avastin, a drug that is widely used in the United States and Europe to keep such cancers at bay. So, with her oncologist’s support, she decided last year to try to pay the $120,000 cost herself, while continuing with the rest of her publicly financed treatment.

By December, she had raised $20,000 and was preparing to sell her house to raise more. But then the government, which had tacitly allowed such arrangements before, put its foot down. Mrs. Hirst heard the news from her doctor.

“He looked at me and said: ‘I’m so sorry, Debbie. I’ve had my wrists slapped from the people upstairs, and I can no longer offer you that service,’ ” Mrs. Hirst said in an interview.

“I said, ‘Where does that leave me?’ He said, ‘If you pay for Avastin, you’ll have to pay for everything’ ” — in other words, for all her cancer treatment, far more than she could afford.

Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones.

Greg Mankiw has more.

18 Responses to “The Traps Of Universal Healthcare”


  • Gregory D. Pawelski

    The anecdote from the United Kingdom has nothing to do with any traps of universal healthcare.

    According to NCI’s official cancer information website on “state of the art” chemotherapy for breast cancer, it is unclear whether single-agent chemotherapy or combination chemotherapy is preferable for first-line treatment. No data support the superiority of any particular regimen.

    Avastin is not the only drug that can be used to treat breast cancer. The idea that approving drugs based on “population studies” has its limits. What may or may not work for the average population may not apply to the “individual.”

    What should be at issue is not on the types of expensive drugs that are being developed and if universal healthcare will pay for them, but on the understanding of all the drugs we already have (many of them cheap). The system is overloaded with drugs and underloaded with the wisdom and expertise for using them.

    A major obstacle in controlling cancer drug prices is the widespread inappropriate use of anti-cancer drugs. As the increasing numbers and types of anti-cancer drugs are developed, oncologists become more and more likely to misuse them in their practice.

    Knowing the drug sensitivity profile of a specific cancer patient can allow the treating oncologist to prescribe a therapy that will be the most effective against the tumor cells, before placing these expensive and potentially toxic agents into the patient.

    Pharmaceutical companies focus their research on diseases with a broad base, and prefer developing drugs that customers can be counted on to take for many years. However, they have come to recognize that cancer drugs can be profitable, if the price is high enough and the disease is serious enough to treat. They have discovered that many patients will tolerate high prices, and demand payment, if their lives depended on them.

    Too many drugs shrink tumors but don’t bring about any survivability. And too many drugs makes it difficult for oncologists to sort out which drugs are most effective alone or in combination, and in what sequence. The result is millions of dollars is spent producing tumor-shrinking drugs that often offer no improved survival, no better quality of life, and no added safety to patients.

  • I get all of that and to a large degree agree with what you are saying. However, the point of the post is different.

    The question I am raising is: Should they lose basic benefits if they choose to pay for these marginal services with their own money?

  • Gregory D. Pawelski

    Okay. I can go along with that. But the title is a little deceiving. This anecdote has nothing to do with it being an example of a trap in universal healtcare coverage. Health care is not a commodity, when human life is concerned. In universal healthcare coverage, doctors will still be independent contractors and everyone will have relative access to health care. I’m sure that people with money will try to circument the system, just as they do under the for-profit system. But I feel they will not be as successful at it. And there will be the potential for waiting for service, just as it happens under the for-profit system.

  • Well, the way the British Health Care System responded does make it a trap. It basically said that if you use the British Health Care System you have to only use the British Health Care System. You cannot use your own money to get superior health care benefits somewhere else.

  • Gregory D. Pawelski

    A good example of the U.S. health care system in this regard is nursing home residents under medicaid/medicare. You cannot use your own money (or from relatives) to pay the difference to get a superior private room, instead of a semi-private room. You either take the semi-private room or pay for the private room out of your own pocket. Before anyone says anything about medicaid/medicare being like a so-called “socialized” system, the Medicare Part D Prescription Benefit Plan is a perfect example that it’s not. This administration set up dozens of for-profit entities (by bribery) to compete with medicare, and medicare still does a better job at it.

  • So the way I see it you have four scenarios:

    Case UK1: British person has no private healthcare but gets free (albeit not the best) cancer treatment.

    Case UK2: British person either is rich or has private healthcare that offers the best treatment on top of free healthcare treatment.

    Case US1: US person has no private healthcare and gets no treatment.

    Case US2: US person either is rich or has private healthcare taht offers the best treatment on top of free healthcare treatment.

    UK definitely looks better here. At least you get something!

  • Not so, the USA has healthcare for the poor. It’s called medicaid.

    Experience with that is one of the many reasons why I am against more single-pay healthcare.

  • To be honest, I’m not familiar with medicaid. I know it exists but I have never experienced it nor have I heard anything good about it. I’m assuming somebody with standard British healthcare fares a better chance than somebody who just has medicaid.

  • Medicaid is health insurance for the poor. So its simply not true that the poor have no healthcare.

    Btw, if your argument is that medicaid is inefficient (which I agree)…then on what justification do you suggest we increase government control of healthcare? It seems to me that if we cant get the healthcare thing right for those who need it most (the poor) chances are we would make it even worse for those more well off. Don’t you think?

  • To be honest, I have no clue. I don’t know enough about healthcare. I’d love to study it in detail and look at what other countries are doing. Surely, they are making mistakes, but I’m willing to believe that we can learn from anybody.

    I do think that 40 million uninsured Americans is unacceptable. Our healthcare system is not functioning at a sufficient level if such a high percentage of Americans cannot afford healthcare, especially since many of these people are hard working individuals. This is the same, in my humble opinion, as saying that 25% unemployment during the Great Depression is unacceptable. Our economic system did not work then just as our healthcare system does not work now.

    Just as we evolved automatic economic stabilizers to maintain acceptable economic levels of unemployment and inflation, I think we should do the same for healthcare. Just as government policy and private stimuli are used to maintain acceptable levels, we should find a similar solution. How that will happen, I’m not sure. I don’t claim to know much about healthcare but I’m sure a solution is out there.

    Every decision has a cost, right? I suppose we just have to balance out what we are willing to give in order to get something a bit more acceptable.

    The 40 million Americans without insurance are not part of the current inputs into the healthcare industry. Servicing them will not necessarily have such a negative impact since they were not inputs to begin with. Servicing them will only increase the market perhaps similar to how the government increases investment and the money supply but purchasing bonds. Thus this possibly could create further growth within the industry?

  • I do think that 40 million uninsured Americans is unacceptable. Our healthcare system is not functioning at a sufficient level if such a high percentage of Americans cannot afford healthcare, especially since many of these people are hard working individuals.

    This is a big assumption. Remember, ‘the poor’ already have health insurance…medicaid. So if you have 40 million uninsured, you have to immediately be suspect as to what their status is – cuz poor is certainly not it.

    Greg Mankiw sheds light on who exactly these people are (I highly recommend the full article as well):

    “To start with, the 47 million includes about 10 million residents who are not American citizens. Many are illegal immigrants. Even if we had national health insurance, they would probably not be covered.

    The number also fails to take full account of Medicaid. the government’s health program for the poor. For instance, it counts millions of the poor who are eligible for Medicaid but have not yet applied. These individuals, who are healthier, on average, than those who are enrolled, could always apply if they ever needed significant medical care. They are uninsured in name only.

    The 47 million also includes many who could buy insurance but haven’t. The Census Bureau reports that 18 million of the uninsured have annual household income of more than $50,000, which puts them in the top half of the income distribution. About a quarter of the uninsured have been offered employer-provided insurance but declined coverage”.

    Many more are probably recent college graduates in their early 20’s who don’t need health insurance and would rather be compensated in the form of higher pay than in a coverage they will rarely use. I know I would.

    So again, this ‘tregedy’ you speak of is anything but.

  • Hmm, you know, you are absolutely right. 47 million isn’t bad, and I’m sure all of those people either don’t need it, don’t deserve it, or don’t want it. Medicaid is also sufficient as well for those who don’t have “normal” insurance.

  • Now you are going too far. I never said it wasn’t bad, I never said ‘all’.

    My belief is that it is ‘bad’ just not the tragedy many make it out to be.

  • Hispanics have asked and HAVE recieved for the American goverment, substancial aid.

    Do the Hispanics understand, you have to work for a living?(other then the easy way selling drugs)

    America is in a crisis, because the Hispanics take…take…and don’t want to give back.

    That is why, it’s not a racist thing…but America is on it’s knees, Hispanics, want ppl to feed them, and not work

  • We have a young hispanic girl at work…she popped out 3 kids, she is only 19.

    She got her stimuls check, ( 1500 ) did she save it to buy school clothes for her 3 kids? No she got a freaken tatoo.

    Went out drinking, bought cocaine…financed by the US Government…

  • I suppose the most rational course of action to any issue is to use a singular anecdotal piece of evidence and apply it to an entire subset, thus accurately proving a point predecided by personal bias.

  • Anecdotal evidence is not everything…but its also not nothing. Its also, btw, a criticism one make to both sides of the health care debate.

  • I directed that at Joni’s comment. I’m not really sure where it fits in the healthcare debate. Just sounds like a poorly veiled rant against hispanics and the fact that we all use government handouts to buy crack.

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