Opinion Editorial
December 3, 2007

By Linda Gorman

On September 8, 2006, the Scottish Medicines Consortium (SMC) told patients with advanced gastrointestinal cancer to go home and die. Some Colorado health reformers want to be able to say the same thing. They want a Scottish Medicines Consortium for Colorado, yet another group of “stakeholders” empowered to give “patient-centered” advice that tells people what to while denying health care to all in the name of controlling costs.

People who want to play God with Colorado health care say that they are fixing “a broken system.” They assert that more centralized controls on drugs, doctors, health plans, and hospitals will lower costs and improve quality. They do not discuss how groups like the Scottish Medicines Consortium actually operate. The reason is that American private insurers are paragons of quality when compared to the SMC.

The SMC is a small group of “stakeholders,” people representing health care professionals, patients, policy experts, and managers. It operates under the fiction that majority votes by an unelected group can provide “patient-centered” health care for 5 million people.

Like its Scottish counterpart, a Colorado SMC would control drug access for Coloradans dependent on government medical treatment. Current reform proposals will force many Coloradans with incomes up to 300 or 400 percent of the federal poverty level (FPL) to transfer from private insurers to an untested Medicaid look-alike program of stunning complexity. According to the 2000 census, about 80 percent of all Colorado households have incomes under 400 percent of FPL. In 2007, single people with an annual income under $40,840, and families of four with an income under $82,600, were in that category. It often costs less to let people die than to treat them.

A Colorado SMC will deny access to drugs that work. As the Scottish Medicines Consortium wrote, “In uncontrolled trials sunitinib (a prescription drug) has been associated with tumour responses in patients who have metastatic renal cell cancer. However, the economic case has not been demonstrated.”

The “economic case” was a comparison of sunitinib treatment to the best “supportive care.” Supportive care makes one’s death less unpleasant. According to SME estimates, sunitinib treatment would have cost £34,000 to £81,000 per quality-adjusted life-year (QALY). In Britain, unofficial estimates of National Institute for Health and Clinical Effectiveness thresholds for new treatment approvals by the national health authority require that costs be lower than £20,000 to £30,000 per QALY. Never mind that QALY estimates are anything but transparent, vary considerably depending on the method used, and do not reflect what people are actually willing to pay.

When health care is tax supported, patients are a cost. It often costs less to let people die than to treat them. When the people in question are gravely ill with a mortal disease for which no certain cure exists, government denials are easy to rationalize. The short run gains are small and expensive, and only over decades do many small innovations begin to make much difference.

In America, private money still pays for most medical care. Private payers value small improvements. Private entities are more likely to pay for small innovations that patients want, things that ameliorate illness, slow disease progression, or improve functioning. The payments make the sick an opportunity for businesses seeking profits. They vie to find new drugs, new cures, and new treatments. Thousands of small improvements add up. Today, many Americans with cancer have a chronic diseases rather than a death sentence.

The reformers obsessed with “fixing a broken system” deny that tax support will be a problem in Colorado. They claim that eliminating profits and private spending here will produce a far different outcome than it has in other countries.

Such claims lack empirical support. The Veterans Administration (VA) is the largest government run health care system in the U.S. In 2000, Blumenthal and Herdman reported that and that the VA formulary slower to add new drugs and less generous than that of private plans. Like the Scottish Medicines Consortium, the VA did not consider sunitinib until late 2006. It refused to include it in its formulary despite a December 28, 2006 VA drug monograph said that sunitinib “should be available for use.” Economist Frank Lichtenberg calculates that the government controlled VA formulary has reduced VA patient life expectancy by up to 2 years.

Unlike the VA, American private plans like Kaiser-Permanente, Cigna, Aetna, Anthem, and Humana, include sunitinib in their formularies. So do private Medicare drug plans and the Federal Bureau of Prisons.

Tax supported health care means government control. Government control means a SMC for Colorado. The next time someone suggests that more government control will “fix the broken system,” keep in mind that in the real world American felons have better access to new drugs than the government controlled, QALY constrained, Scots.