Must Read Story of the Day
Cancer survivor Bob Tufts fears cost-cutting in health care. Our friend and former MLB pitcher writes at The Huffington Post that he might not be alive if he suffered under British-style cost-cutting.
“I have a personal reason to abhor any cost-effectiveness program in the United States that proposes using QALY as a standard for care,” writes Tufts, who was diagnosed with multiple myeloma in 2009. “At the time that I was treated, most multiple myeloma patients were dying in one to three years. In the United Kingdom — the home of QALY based care — my novel treatment protocol had not yet been approved under their national health plan due to cost concerns and the statistical likelihood of its limited extension of a patient’s life.”
“If these rules had been in effect in the United States in early 2009, I probably would not have survived — and those that endorsed these theories would have surely been complicit in my premature death from cancer.”
Tufts is among the growing number of patients worried that the Institute for Clinical and Economic Review is copying the cost-cutting measures imposed by the National Institute for Health and Care Excellence in the United Kingdom.
Tufts doesn’t mince words: “If these soulless administrators get their way and QALY restrictions become the accepted method of dispensing care in the United States, it will cause thousands of people like me with life-threatening but treatable illnesses to be denied medically justifiable care and could thwart the continuous innovation process that leads to the development of new and better medications in the future.”
UnitedHealth’s Pharmacy Benefits Division: $20.6 billion for the Quarter
Contrast patients’ struggle to gain access to care with this next story: Once again, the country’s biggest health insurance company has posted billions of dollars in profit.
Reuters reports that UnitedHealth’s incredible quarterly profits are owed to its pharmacy benefits manager, “Revenue from the company’s Optum business, which manages drug benefits and offers health care data analytics services, rose 51.5% to $20.6 billion for the quarter.” That’s “20.6 billion for the quarter.” 4 months.
Insurance companies, such as UnitedHealth, use pharmacy benefit managers or PBMs to save money by limiting patients’ access to life-saving treatments. Think of them as the middleman that does the dirty work with little regard for what is really best for the individual patient.
“It’s such a complicated web of intermediaries that stand between consumers and the prices they pay,” Erin Fuse Brown, an assistant professor of law at Georgia State University College of Law, recently told Kaiser Health News. “As a result, no one knows if they’re getting ripped off.”
Quote of the Day: Apple, Innovation & Regulatory Uncertainty
“If it took Apple an average of 10 years to bring a new product to market knowing that only 1 out of 10 they invested in would make it to consumers… Apple would still be selling Newton’s and first generation Macs.”
— Robert Goldberg, Vice President, Center for Medicine In The Public Interest
Check out his entire LinkedIn post on the push by some Republicans to embrace Bernie Sanders’ health care policies. Spoiler alert: It’s not great for innovation.
Hospitals Under Weekly Cyber Attacks
America’s hospitals are facing weekly cyber attacks.
Politico reports that, after introducing “a $35 billion incentive program to pay doctors and hospitals to convert to electronic records,” the Obama administration is struggling to respond to threats facing hospitals.
“If they don’t pay up, files get frozen, surgeries delayed and patients sent across town,” Politico reports. “One of these days, someone could die as a result. And no one in government has a clear plan to handle it.”
Some security experts say hospitals have failed to properly invest in security.
“If you peer into the dark minds of a lot of hospital executives, they are rolling the dice as to where they allocate their budgets,” said Clinton Mikel, an attorney with Health Law Partners.