Friday, April 14, 2006


Patients will be denied access to drugs at the forefront of medical research after a landmark judgment on the breast cancer treatment Herceptin. The Court of Appeal ruled yesterday that it was illegal for health trusts to discriminate against patients by funding expensive unlicensed drugs case by case. The ruling means that trusts will now either have to agree to pay for a new drug for any patient whose doctor recommends it - with serious implications for NHS budgets - or refuse the treatment for the entire population it serves. Dozens of drugs that do not yet have a licence for certain uses - including treatments for life-threatening conditions - which are prescribed by doctors could be affected.

The decision came as Tony Blair and Patricia Hewitt, the Health Secretary, held an emergency meeting at No 10 to address concerns about spiralling health service deficits, which are expected to pass 800 million pounds for the past financial year.

The hearing at the Court of Appeal came after a lengthy legal battle between Ann Marie Rogers, a grandmother from Swindon, and her primary care trust (PCT). The PCT had decided not to pay for Mrs Rogers's treatment with Herceptin on the ground that she was not an exceptional case. Ruling in favour of Mrs Rogers, the court said that the trust's policy of judging patients case by case was "irrational and unlawful".

Health leaders last night gave warning of the unintended uncertainty that the judgment would create for future drug provision. Gill Morgan, chief executive of the NHS Confederation, representing more than 90 per cent of NHS organisations, said that the decision held "significant implications for the prescription of all unlicensed drugs - not just Herceptin".

Herceptin is licensed for treatment of women with advanced breast cancer but is unlicensed for treating early-stage sufferers. Swindon PCT had argued that Mrs Rogers, 54, was not an exceptional case deserving of a drug that had neither been licensed in Britain for her condition nor appraised for NHS use. Many of the 300 PCTs in England and Wales follow a similar policy.

Mrs Rogers, who has received Herceptin during her legal battle, will now be allowed to continue taking the drug while Swindon PCT addresses its policy. The trust's policy was to fund Herceptin without regard to financial considerations in cases in which it was prescribed by a clinician and it was decided that there were exceptional clinical or personal circumstances.

The Court of Appeal ruled that in considering what might be such an exceptional case, personal circumstances "are irrelevant as soon as financial considerations are disregarded". In a unanimous judgment, the Master of the Rolls, Sir Anthony Clarke, Lord Justice Brooke and Lord Justice Buxton said that the court could not - and should not - order the PCT to provide Herceptin.

Jan Stubbings, the chief executive of Swindon PCT, said that in terms of the law, it had a statutory requirement to balance its books. "The jury is still out, so we need to make sure we do not overhype Herceptin," she said. "It is one of many new treatments."

Research suggests that Herceptin, which has been shown to halve the chances of a tumour returning, would be highly beneficial for early-stage sufferers. It targets the HER-2 protein - which can fuel tumour growth - present in about a fifth of sufferers. However, it has been linked to heart problems and, at 20,000 pounds a year, is a severe drain on NHS budgets.

Outside court, Mrs Rogers, 54, said the "humanitarian" ruling had given her back her future. "I feel I've taken on the world and beaten it, not just for me but for everyone else."



Massachusetts will likely soon become the first state in the nation to force everyone living within its borders to buy health insurance or pay a tax for walking around uninsured. Gov. Romney says by signing such a mass mandate into law, he will achieve the Democrats' goal of universal health coverage on Republican market-oriented principles. Uh-huh.

After HillaryCare was defeated a decade ago, the fight for "universal care" moved to the states, where lawmakers are pushing for it piecemeal in two ways: broad new government mandates, and incentives for employers to cover more people. It's now clear which approach Mr. Romney favors as he considers running for the Republican presidential nomination in 2008.

If there is one redeeming value to his approach, it is that it starts with the presumption that even the poor should pay something for their health care. That's not a trivial point. Today many uninsured patients skip out on their bills and leave their health-care tabs for everyone else to pay in the form of bigger hospital bills and higher taxes.

And it's not a presumption many on the left have been willing to grant. Tennessee was hit hard with the exploding cost of health care after it expanded its Medicaid program in the 1990s to cover anyone in the state who couldn't afford or didn't qualify for health insurance (due to pre-existing conditions or other reasons). Initially the eligibility rules were so loose that some individuals earning $100,000 a year were able to sign up. Not surprisingly, within a few years TennCare was eating up a third of the state's budget and consuming almost all of the new tax revenue the growing economy was sending to the state treasury. Gov. Phil Bredesen, a Democrat, was elected in 2002 in part on a mandate to restrain TennCare and not to create an income tax to pay for it.

After taking office, he managed to remove tens of thousands of people from the rolls, but he soon realized that it was impossible to manage costs without also requiring nearly everyone to pay something for the care they received. Otherwise, as he told me, it's like shopping in a grocery store that doesn't have any price tags and where you don't have to pay the bill at the checkout counter. Requiring consumers to pay at least part of the bill is essential to striking a reasonable balance between consumption and total cost. That means copayments for drugs and doctor visits, deductibles, or other fees.

For pointing this out, Gov. Bredesen has been blasted by Sen. Ted Kennedy and other Democrats. Gov. Bredesen is now pushing his own new health-care program that's based on incentives. He wants the state to pay for a third of the cost of premiums for those who work for companies with fewer than 25 people. He estimates coverage would cost about $150 a month for insurance with reasonable deductibles, copays and other fees--leaving the state with a bill of $50 a person. He proposed his plan in recent weeks, says he'll consider it a success if it enrolls 100,000 people (the state has about 600,000 uninsured residents), and is making it a centerpiece of his re-election campaign.

What Tennessee and Massachusetts now have in common is that as lawmakers look for health insurance plans that are cheap enough for most people to afford, they're going to run headlong into the reality that buying health coverage is very expensive. The reason isn't just that health care across the country is expensive. It's also that health insurers are prohibited from offering coverage that pays for only catastrophic events, such as a serious injury or heart attack. Rules vary by state, but in most places insurers are forced to cover everything from routine checkups to chiropractic care. Remove these mandates, allow deductibles and "copays" to be raised high enough, and in an instant the price for some health plans would fall to about that of dinner out and a movie for two.

Tennessee's approach is to create a new government program that will likely claim more taxpayer dollars down the road, starting with new tobacco taxes. True, as one lawmaker put it recently, the governor isn't promising the "Cadillac" of health coverage. Instead lawmakers are starting from the assumption that the program will cost the state $50 a person and are shopping around to see what kind of coverage can be bought at that price. If in the process Tennessee removes the government controls that increase the cost of health coverage and opens the market for insurance aimed at low-income workers, the Volunteer State may yet become a laboratory for market-oriented health care policy.

But Massachusetts' Legislature is unlikely to remove the rules that push up the price of health insurance and is looking instead to cover the working poor the old-fashioned way, with government subsidies. In addition to making health insurance mandatory (taking away tax deductions for those who don't buy insurance), the legislation Gov. Romney is about to sign expands the state's Medicaid rolls, levies a $295 per-employee "fee" on businesses that don't offer health insurance, and sets up a government board to approve new health plans.

The rhetoric from the Bay State's governor notwithstanding, RomneyCare will turn out to be not only expensive but also a mandate for more government spending and more government intrusion.



Michael Savage began having trouble swallowing in December. Under Canada's system of socialized medicine, the wait for an MRI - which detected the tumor - was six weeks. By then, the cancer had grown and spread to Savage's lymphatic system, and swallowing was almost impossible. The surgery involved removal of the tumor from the esophagus and heart, plus removal of one-third of his stomach.

More here


For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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