Arnold Kling  

Poster Child for U.S. Health Care

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A British reader forwarded this. Note that in order to get life-saving treatment, the boy apparently must go to the U.S.

Overall, I am not a huge fan of our health care system, but one thing that I suspect that it does better than other systems is offer hope to people with rare or difficult illnesses.


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COMMENTS (26 to date)
z writes:

Great post.

For all those people who love rolling out the "We're 43rd in the world for health care" pseudo-statistics. Looks like when you're child's life hangs in the balance, those other 42 places sometimes just don't cut it. How's that for scarcity...when the potential treatment can't be purchased in your own country at any price.

Francis writes:

That kind of fundraiser is not rare in Canada, where the goal is to send the sick person to the US for treatment unavailable here.

Better still: the premier (prime minister) of the province of Quebec himself, in the 90s, got treatment for his skin cancer in Washington, D.C. It seems (to be confirmed) that the treatment he received was not yet approved (let alone administered) in Canada.

Better still: in the early 2000s (if memory serves me), when hospitals were even more congested than usual in Quebec, the health minister contracted US hospitals to receive the overflow of patients that we had. (They said they were well treated.) Strangely enough, nobody suggested that instead of sending our patients to capitalist health-care, we should let capitalist health-care come to our patients.

SydB writes:

"but one thing that I suspect that it does better than other systems is offer hope to people with rare or difficult illnesses."

True. But often false hope. Or gruesome complications. And at an enormous cost.

Greengenes writes:

"Overall, I am not a huge fan of our health care system, but one thing that I suspect that it does better than other systems is offer hope to people with rare or difficult illnesses."

Correct. I think however it is an advantage or disadvantage depending on how you look at it.

Why treat a disease that would save 10 people a year vs one that could save 1000 people a year. In this situation if it is more profitable to treat the 10 people, with limited resources, it will result in a net loss of life. If the government mandates the treatment that would save 1000 people you would deny those 10 people any opportunity of treatment. It's the matter of how you prefer to ration resources.

Also I've seen many charity jars in the U.S. for what I assume are the uninsured or under insured with various life threatening illnesses. I doubt all of them acquire the necessary funds via charity. Would they be treated in the UK....maybe, maybe not, but all citizens would be treated equally for better or worse.

Francis writes:

"Often false hope... gruesome complications... at an enormous cost."

Please clarify your thought. At face value, your text looks like an argument to shoot the horse rather than try to save it.

Dan Weber writes:

Looks like when you're child's life hangs in the balance, those other 42 places sometimes just don't cut it.

Of course. Everyone wants insurance at a reasonable cost, but the trade-off is that there is going to be some time, some where, where it won't cover you, even when you "need it to live."

I think people in the US should be able to choose a "we cover reasonable things" or a "we cover EVERYTHING" policy, paying appropriately more for the second. But the market doesn't really allow for that choice right now.

True. But often false hope. Or gruesome complications. And at an enormous cost.

One example is radical chemotherapy from the 80's/90's.

z writes:

"Of course. Everyone wants insurance at a reasonable cost, but the trade-off is that there is going to be some time, some where, where it won't cover you, even when you "need it to live."

You're missing the point. This goes beyond insurance and who pays for care, etc. This isolated case simply proves the fallacy of the claims that our health system is anything but the most advanced offered in the world.

For all the talk of 'we spend more than anyone in the world on healthcare, and what do we have to show for it', well, here you go.

We probably spend more than anyone in the world on education, legal services, professional athletes, and BMW's, too - because we're the wealthiest country in the world. Our healthcare system is full of waste. But at the end of the day, we are able to do things other people can't.

What kind of signaling is a poster child?

RL writes:

I'm a physician. I discussed this with a pediatric oncologist. Most neuroblastomas present late, when standard treatments are not helpful. It is not surprising that NHS's cost-benefit analysis would not support treatment. Sloan-Kettering offers experimental treatments that may well not work either, and of course are very expensive. I'm not sure every US health insurance policy would cover them either.

The important point is that all the money in the world can't buy experimental care in the UK. It's not done in the UK. It's done in the US. There's a reason for that.

SydB writes:

I'm not saying "shoot the horse." Just that I think there seem to be a lot of procedures in the US-e.g. back surgeries, knee surgeries, etc--that result in no better outcome than if the procedure had not been performed. And I've not the fact at my fingertips, but I've read that life extending procedures, near end of life, buy something on the order of a couple months. At enormous cost. A large transfer of money from the young to the old.

I don't argue that the US has some of the best high tech procedures that money can buy. Which is great, but also part of our problem.

Debbie writes:

65% of US Physicians are against the current NEW bill. Yet 45% say they will "close their practice and retire if it is passed.."

941,000 physicians in USA will drop to about 450,000

If that happens, each physician will have to tend to 3000 patients apiece. Impossible!!!

That's the poll we all need to pay attention to.

If so, then what will we do, go to Canada?

And it may be a surprise to all that orthodontists are the highest income earners, not physicians!

Dan Weber writes:

Yet 45% say they will "close their practice and retire if it is passed.."

If so, then what will we do, go to Canada?

There should be plenty of people there already, given the millions of people who threaten to move to Canada every election. They all moved, right?

Douglass Holmes writes:

People also leave the US to get treatment abroad. I recall a child from Kentucky went to China to get a treatment that wasn't available here. It was experimental, of course. Others have gone to Mexico for cancer treatments that we won't allow here. Some go abroad just to get cheaper healthcare. This will continue regardless of the outcome of the current healthcare debate here.

Methinks writes:

And I've not the fact at my fingertips, but I've read that life extending procedures, near end of life, buy something on the order of a couple months. At enormous cost. A large transfer of money from the young to the old.

You're right, but that problem exists because we have so much socialized medicine already. It's not for me to decide whether a gruesome treatment has value to particular individual. I have no problem with people wanting to fight for their life until the bitter end - but they should pay for the pleasure.

If so, then what will we do, go to Canada?

Debbie, U.S. physicians are already opening clinics in Asia. Resort towns in places like Mexico and the Caribbean were also mentioned to me. This is anecdotal evidence, of course. I don't know how many would and it's doubtful enough would open to meet demand.

However, those physicians will probably only take cash payment and cash payments will be harder to come up with when the tax rates are jacked up to the sky in the U.S. to pay for destroying the already limping U.S. healthcare system.

Dr. T writes:

Childhood neuroblastoma is treatable and often curable with surgery and chemotherapy. The costs are relatively low compared to other cancers that require bone marrow transplants. There is no good reason why a medically advanced, first world nation cannot give this boy timely treatment. Each day they wait to raise money increases the likelihood of a bad outcome. The family should raise money by kidnapping and ransoming the top brass of the National Health Service. (Alternately, they could kidnap the NHS brass, tie them to posts, and charge fellow Britishers a thousand pounds per stone.)

RL writes:

Dr. T: What you say is true of lower stage neuroblastomas. I'm sure the cases seeking help at Sloan-Kettering are Stage IV disease. It seems NHS has done a cost-benefit analysis and chooses not to treat these patients aggressively.

David N. Welton writes:

I'm not sure what the latin term for the debate tactic would be, but "debate by posting pictures of cut kids" is not something I think moves the discussion forward much. I'm sure you could find cute kids in the US who died because of some failing of the health care system there.

z writes:

"I'm not sure what the latin term for the debate tactic would be, but "debate by posting pictures of cut kids" is not something I think moves the discussion forward much. I'm sure you could find cute kids in the US who died because of some failing of the health care system there."

Apparently a REAL situation from the REAL world, doesn't fit into your narrow view of current discussions on health care. The English term for this is 'an example'.

It doesn't claim to sum up the health care debate. It merely illustrates the point that, much to the chagrin of those claiming otherwise, impressive medical feats are performed in the US (and the rest of the world freeloads off our advances...but that's another issue).

Dan Weber writes:

They are called anecdotes. And they aren't data. There was that kid who died from the tooth abscess in the US that any dentist could have treated. Liberals love to bring him up, but he's just an example.

I think it's great that the US lets people who want to pay extra for experimental treatments get them. However, it's very hard to get out of that system if you just want reasonable care at a reasonable price. Since so much of our health care is paid for by third-parties, we can only judge third parties based on what they do and don't approve, and we want them to approve everything.

Tom West writes:

Better still: in the early 2000s (if memory serves me), when hospitals were even more congested than usual in Quebec, the health minister contracted US hospitals to receive the overflow of patients that we had. (They said they were well treated.) Strangely enough, nobody suggested that instead of sending our patients to capitalist health-care, we should let capitalist health-care come to our patients.

Francis, you realize that any sane capitalist would use the same system that Canada does if in Canada's position. There is *no* system in which it would make sense for Canada to have facilities that would service a handful of Canadians for prices in the $100,000 to millions range when the US facilities can manage 10x better economies of scale.

For services such as this case, it only makes sense to have 1 or 2 places in the world specialize. After all, isn't not as if those who have a half-million to spend on treatment can't afford a trip to the US.

Likewise, it makes makes a lot of sense for Canada to send patients to the USA for temporary overflow problems rather than build capacity for the absolute maximum number of patients that are needed, especially given that parts of the US have excess capacity that is costing the US an arm and a leg. From my perspective, this is Win-Win. Canada doesn't have to build capacity that will normally stand idle, and the USA helps defray the cost of their excess capacity.

(By the way, occasionally you will find US hospitals sending patients to Canada when there is the opposite supply situation. Oddly enough, the hospitals seem simply be interested in best serving the patients rather than playing 'gotcha' across the borders.)

Tom West writes:

An question from a Canadian. I know that in the USA, if you need emergency treatment, you can get it at any hospital and they must treat you (at least in theory) even if you have no insurance or means to pay for it. (They can come after you for payment later, of course.)

However, many, if not most, serious problems are not emergency problems. What happens in cases like cancer or any progressive disease where there is no 'instant' of emergency? If the child in the poster was an American but among the many millions of uninsured, could he walk into any hospital and get the treatment he needed, even if he couldn't pay?

Slugger writes:

I join in the outrage at the way that this child is being treated in the UK. No child, indeed no person of any age, should be denied reasonable and appropiate medical care by any community aspiring to be a member of the first rank of nations. Any modern nation will provide such care.

David N. Welton writes:

Anecdotes vs Data

Sure, it's an example, but any bozo (on any side of the debate) can post pictures of cute kids in pain, however, I expect something a bit more from folks like Dr. Kling. His point is a good one, but I'd rather see data: where does the money come from that allows those kinds of advanced treatments? How many people in the US are denied those sorts of treatments? Who pays for the research? What's the research spending like in other countries? How might different health care systems affect that? Someone else points out that there is free riding going on. How might that change with different health care or research systems? That kind of stuff is what I want to see from economists, not simple tugging at the heartstrings, which, as stated previously, can be done by both sides.

Denis Byrne writes:

The fact that treatment for a relapsed neuroblastoma in an infant is available in the USA but not in the UK is the important point. What differences between the systems caused that outcome?

NIH has been doing neuroblastoma research since at least the 1960's & several clinical trials of treatments of childhood neuroblastoma are now underway http://www.cancer.gov/cancertopics/pdq/treatment/neuroblastoma/HealthProfessional/page7

A neuroblastoma search of the NHS Choices site yields two(2) results: (1)Alkeran injection (used for multiple cancers) & (2) a referral to a charity doing research. http://www.nhs.uk/Search/Pages/Results.aspx?___JSSniffer=true&scope=&q=neuroblastoma

NHS currently employs 1.4 million people most of whom are involved in administration & are not directly delivering health care. NHS consumes 98.4% of the UK Health Dept budget.

Chip writes:

From the 2SimpleTrust web page:

Sloan-Kettering

There is a poor prognosis for those diagnosed with neuroblastoma and, in particular, a low survival rate for those patients diagnosed with high-risk neuroblastoma. Many children respond initially to conventional treatments such as chemotherapy and radiotherapy but unfortunately, often relapse.

Immunotherapy is a new innovative therapy under clinical trial at the Sloan-Kettering Hospital in New York State which is designed to train the body’s immune system to detect and destroy neuroblastoma cells that have survived chemotherapy and radiation therapy. This involves the injection of monoclonal antibodies into the bloodstream which seek out and attach to neuroblastoma cells and signal for the immune system to destroy them.

The Sloan-Kettering’s ability to conduct immunotherapy trials is largely thanks to its being the grateful recipient of a $20 million grant for cancer research from the Ludwig Fund. Such funds are not available to hospitals operating within the UK and this has meant that those children suffering from neuroblastoma must travel to the US in order to receive immunotherapy treatment which seeks to treat neuroblastoma cells which have become resistant to chemotherapy and radiotherapy and to minimise the likelihood of relapse through the elimination of MRD.

I'm going to guess that in the US many insurance companies wouldn't cover this treatment because it is "experimental." So, even here your ability to get this treatment if you need it would depend on the charity of others, including Sloan-Kettering.

Denis Byrne writes:

I agree with your supposition & suggest that the same outcome (no coverage) would occur under the current U.S. system or if something like HR 3200 or the Bachus approach were adopted because, like the UK, both approaches depend upon bureaucratic value judgments for cost control. However, if we adopted a plan that combined high deductible catastrophic insurance coverage linked to tax subsidized HCSA we would get an effective brake on HC cost growth and the child would get the immunotherapy that he needs.

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