Saturday, July 5, 2008

Health Policy: Universal Health Care

The New York Times has an in-depth story on a cancer drug, Avastin, and its positive but largely marginal benefits to patients. The problem: It's a really expensive drug.

What's a doctor, a patient, an insurance company to do?

From the article:

"Dr. Winer says that when he is not sitting in front of a patient, he thinks about whether drugs like Avastin are worth it to society. But when facing a seriously ill patient, who, based on clinical trial results, might benefit — even if only a little — from Avastin along with chemotherapy, he has to think about his patient’s needs.

“I can’t say, ‘Let’s not use Avastin; it’s a very expensive drug and I am worried about the cost to society,’ ” Dr. Winer said."

And here's one of the problems with rushing into 'universal health care' before we figure out and communicate to the public what that means in practice. What will be covered and what will be excluded? Who will decide?

You can think about health care, for society as a whole, as having three desirable characteristics: Ideally it would be of low cost, high quality and accessible to all. The problem is that you cannot independently maximize each of these dimensions: there is no such thing as low cost, high quality health care for everyone. You have to give on at least one of these dimensions.

So: You can have cheap health care for everyone, but it's quality will not be maximized.

Or: You can have high quality health care for everyone, but it's going to cost you big bucks.

Or: You can have cheap and high quality health care, but you are going to have a heck of a time delivering this to everyone.

So, before I am willing to go for 'universal health care', I want us to face up to this reality and articulate what it means.

A society where so many are convinced that they should never grow old, should never die, no matter how they neglect their basic health, is not the ideal spot to implement universal health care.

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