The Drug That Could Break American Health Care | Hacker News Reader

The Drug That Could Break American Health Care

theatlantic.com

6 pointsbequanna3 comments

Open articleView on HN

In opposite news I learned this week a mild form opium grows in most peoples yards around the world.

* https://en.m.wikipedia.org/wiki/Lactuca_canadensis

* https://en.m.wikipedia.org/wiki/Lactucarium

Hmm, it's one thing to argue that FDA shouldn't approve the drug because of concerns around efficacy.

But to complain that it's approval is a bad thing because it'll affect cost of healthcare seems bit weird.

Shouldn't the discussion of approval (efficacy vs side-effects) be separate from the discussion of which patients, if any, should be offered the treatment (benefit vs cost).

It should be, but I don't think it currently is. Maybe an expert will chime in, but my understanding is that Medicare/aid have to pay out if the treatment is "reasonable and necessary". Whether cost/benefit can be considered as part of the "reasonable" distinction is still an open question, as the article notes.

There's also a healthy debate to be had about whether we should be debating cost vs benefit in healthcare. Refusing to treat someone will likely mean they die; should we be stepping into that arena? How do we calculate "benefit"? Is it benefit to that person, or their family, or to society in general?

There are some negative externalities, though.

People who can afford the treatment will pay for it. Inheritances will cease to exist except for those wealthy enough to both pay for treatment and still have money left over. I can't imagine being asked whether I would prefer to keep my sanity and live longer, or be able to give my house to my children, but not both.

The poor just won't be able to afford it. If this drug actually worked, it would make Alzheimer's a disease of the poor. They'll get doubly screwed: not only will they be left to die of Alzheimer's, they'll also be the only group that bears the struggle of taking care of relatives with advanced Alzheimer's.

Once we've established that it is okay to consider cost/benefit, that opens a slippery slope. Do we even try to treat cancer when there's only a 3% chance of it going into remission, and the bill is huge? What about babies that are born with expensive to treat diseases? Why do we even bother with the Americans with Disabilities act?

I don't think doing cost/benefit comparisons is a good thing to do at this point. We're struggling with funding, but not struggling to pay for it. I.e. the money exists, either in other programs or in the economy (which can be seized through taxes). Doing cost/benefit comparisons is, to me, a measure of last resort. If we genuinely cannot afford to treat people, then it makes sense to ration.

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