Death By Ideology
By PAUL KRUGMAN
Mitt Romney doesn’t see dead people. But that’s only because he doesn’t want to see them; if he did, he’d have to acknowledge the ugly reality of what will happen if he and Paul Ryan get their way on health care.
Last week, speaking to The Columbus Dispatch, Mr. Romney declared that nobody in America dies because he or she is uninsured: “We don’t have people that become ill, who die in their apartment because they don’t have insurance.” This followed on an earlier remark by Mr. Romney — echoing an infamous statement by none other than George W. Bush — in which he insisted that emergency rooms provide essential health care to the uninsured.
These are remarkable statements. They clearly demonstrate that Mr. Romney has no idea what life (and death) are like for those less fortunate than himself.
Even the idea that everyone gets urgent care when needed from emergency rooms is false. Yes, hospitals are required by law to treat people in dire need, whether or not they can pay. But that care isn’t free — on the contrary, if you go to an emergency room you will be billed, and the size of that bill can be shockingly high. Some people can’t or won’t pay, but fear of huge bills can deter the uninsured from visiting the emergency room even when they should. And sometimes they die as a result.
More important, going to the emergency room when you’re very sick is no substitute for regular care, especially if you have chronic health problems. When such problems are left untreated — as they often are among uninsured Americans — a trip to the emergency room can all too easily come too late to save a life.
So the reality, to which Mr. Romney is somehow blind, is that many people in America really do die every year because they don’t have health insurance.
In Cancer Care, Cost Matters
By PETER B. BACH, LEONARD B. SALTZ and ROBERT E. WITTES
AT Memorial Sloan-Kettering Cancer Center, we recently made a decision that should have been a no-brainer: we are not going to give a phenomenally expensive new cancerdrug to our patients.
The reasons are simple: The drug, Zaltrap, has proved to be no better than a similar medicine we already have for advanced colorectal cancer, while its price — at $11,063 on average for a month of treatment — is more than twice as high.
In most industries something that offers no advantage over its competitors and yet sells for twice the price would never even get on the market. But that is not how things work for drugs. The Food and Drug Administration approves drugs if they are shown to be “safe and effective.” It does not consider what the relative costs might be once the new medicine is marketed.
By law, Medicare must cover every cancer drug the F.D.A. approves. (A 2003 law, moreover, mandates payment at the price the manufacturers charge, plus a 6 percent cushion.) In most states private insurers are held to this same standard. Physician guideline-setting organizations likewise focus on whether or not a treatment is effective, and rarely factor in cost in their determinations.
Ignoring the cost of care, though, is no longer tenable. Soaring spending has presented the medical community with a new obligation. When choosing treatments for a patient, we have to consider the financial strains they may cause alongside the benefits they might deliver.
This is particularly the case with cancer, where the cost of drugs, and of care over all, has risen precipitously. The typical new cancer drug coming on the market a decade ago cost about $4,500 per month (in 2012 dollars); since 2010 the median price has been around $10,000. Two of the new cancer drugs cost more than $35,000 each per month of treatment.
Our View: Portland right to ask more from nonprofits
With taxpayers stressed, it's right to ask tax-exempt property owners to help.
The modifier "nonprofit" can make a corporation sound downright humble. But not every nonprofit is a shoe-string operation run by volunteers.
Despite their tax-exempt status, some nonprofits are big businesses that pay their leaders hefty salaries. This is particularly true of big hospitals and affiliated organizations, which take large swaths of prime real estate off the tax rolls. The community benefits from their services and they are big employers, but while other taxpayers are struggling make ends meet, they don't help pay for schools or other services.
This is a thorny, long-term problem for service-center cities like Portland, which give million in tax breaks to nonprofits while trying to figure out how to afford police and fire and public works. And under the law, there is very little that a municipality can do.
Comparing Medicare plans? Ratings show some policies better than others
Posted Oct. 15, 2012, at 9:48 a.m.
Today, Medicare beneficiaries can begin choosing their drug and medical coverage for 2013, and most seniors are expected to stick with the same policies they have already, despite price changes and a rating system that shows some plans may be better than others.
Seniors have been reluctant to change plans, even if there are cheaper or better-rated alternatives, according to recent studies and seniors advocates. Beneficiaries also tend to stay with the same insurers: This year more than a third of those in Medicare Advantage plans, which provide medical and drug coverage, chose policies from just two insurers, UnitedHealthcare or Humana.
For those who are actively shopping, however, a Medicare website offers a consumer-friendly rating system that assigns one to five stars to each plan. Eleven Medicare Advantage plans offered next year earned the top five-star rating and 97 earned four and four-and-a-half stars, compared to 9 and 116, respectively, this year. Four prescription drug plans available in 2013 received five stars, the same number as this year, and 22 drug plans earned four and four-and-a-half stars next year compared to 9 this year.
The ratings are based on information reported by the plans, from Medicare records, and a yearly survey of some beneficiaries. Participation in the surveys is voluntary and anonymous but insurers are concerned that too many seniors opt out. This year about a million seniors were randomly selected to receive one of two surveys and 495,366 responded. Although that is generally a good response rate for most consumer surveys, insurers are encouraging seniors to do better. Medicare Advantage plans serve 13 million beneficiaries, and drug-only plans 17 million.
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