Pussyfooting around

No, I'm not referring to what you probably think I'm referring to. James Chambers and Peter Neumann, in the new NEJM, discuss a treatment for prostate cancer approved by the FDA in April 2010. Sipeucel-T, brand name Provenge, offers a median survival benefit of 4.1 months and costs $93,000 for a usual course of 3 treatments.

Chambers and Neumann (Peter to me -- we were colleagues at Tufts) wander around the relevant regulatory issues. CMS did a review of its coverage policy for Provenge that wasn't completed until March of this year, and maybe that was inefficient, couldn't CMS and FDA have worked together? Well, not really, they have different responsibilities. On the other hand, as long as the FDA has approved it CMS can only consider limiting coverage to cases where it is indicated as effective and can't take cost into account, so if we are worried about the cost what can we do? Maybe we can merge Medicare Part B into Part D and then private insurers can negotiate over the price, which Medicare is not allowed to do . .. Yadda yadda yadda.

What we can't do, and what they can't really talk about because it's apparently a societal taboo -- and it's certainly not within the bounds of current law or policy and it's congress won't go near it -- is a) let Medicare negotiate for a better price and b) let Medicare consider whether $93,000 might be better spent on something else.

Uh oh. Reducing the profits of drug companies = socialism, which is un-American. And actually considering whether taxpayers should spend $93,000 to extend the life expectancy of people who are already very sick by 4 months is rationing = death panels = murder.

Curiously, however, considering not giving people who can't afford it any health insurance at all is perfectly okay, in fact it's the way to defend our freedom against socialists and death panels. Those unlucky people who aren't rich enough won't get Provenge either, but that isn't rationing, it's fiscal responsibility.

See the difference?