"You have advanced kidney cancer. … A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?"

See: http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html?pagewanted=1&em

Let's rephrase that question. Should Medicare pay US$300 per day to prolong the life of a terminally ill cancer patient by 6 months?

Britain's NHS originally said "no" to the same question; then reversed itself under public pressure.

Britain's National Institute for Health and Clinical Excellence (NICE) puts a price of 30,000 pounds (About A$60,000) on one year of life. If the ESTIMATED cost of a life-extending treatment exceeds 30,000 pounds per annum the NHS will not fund it.

Some questions for posters to consider:

--What price limit should Medicare place on life-extending treatments?

--What obligation do the recipients of Medicare benefits have to keep themselves in shape by, for example, keeping their weight under control, exercising reasonably and moderating their alcohol intake?

I also have a modest proposal for posters to consider.

People who do keep themselves in good shape save taxpayer's money. Should they be rewarded with a $100 per year "wellness" bonus?

Parents who ensure their children eat healthily and exercise regularly could get a $200 per annum bonus.

I think the distinction of collecting your wellness bonus at a public ceremony would give the scheme an impact that exceeds the relatively modest amounts involved.

Let's declare 28 September to be National Wellness Day and hand out wellness bonuses in public ceremonies.

Also, wellness bonuses should be doubled in any year in which the Melbourne Demons win the Grand Final.

who dares to put money before life...is not living to live but living for others to die...but as usual the question is phrased incorrectly

the real question is how come those claiming to be in the healing business are in business to make money from others sickness...the story behind the story is fat cats need their pay...and getting gross govt subsidy..gets their bonus

people actualy are getting rich..by others getting sick...thus because of the motivation for gain..are suppressing cheap cures,..just like the petro industrty activly suppresses new inventions..[for over a century]...so too the industries that make huge gain..from others pain

there are hunderds of cancer cures..[but cures get no funding...because a cure means../another cash cow dies...same with tooth decay..that could easilly be cured by an international vacination capmpane..to kill the bacterisal strain..causing tooth rot...but no...special intrests dont want that..thus no cure..cause curtes hurt the bottum line

just as researchers..found..the flue strain..that now is the basis for the pig flue...that is released and beat up only so govts will buy up vacines for compulsory vacinations...and lo the orders are in..yet the cure..preceeded the flue by 6 mths...lol

that vacines allways..somehow..seem to contain live virus..causing real outbreaks...thats the unspoken cause of most epidemics..compulsory vaCINATIONS...read the past links

just as polio virus vacination..in africa/russia,..was the vector for the homo/monkey disease..aids

there are many countries..have their orders for the bird/swine/human hybred flue vacine in..[just like the bird flue..saw govt's spend...BILLIONS on buying up tamiflue...and that other non cure

that now..suprise..suprise is out of date...all that money poured into a scare campain...sure is a nice little earner..from others pain/misery/fear..thats the real crime

those who favour others dying..are eugenisists..regardless of their apparent motivations..like cost...scratch the surface and see the roots of eugenics in the question

You are fascinating Steven.

Oh what about fines for people who marry into families that have a genetic disposition to cancer and other diseases and go ahead to reproduce?

And if a parent of a fat child is spotted at Maccas they could be arrested.

Hey make it illegal to drive to any destination within one kilometer of your home.

And tax back annually to all the smokers that paid for everyone else to get well in hospitals that have not yet had a smoking related disease.

I’m gonna stop myself now but I have a ton of them.[smile]

"those who favour others dying..are eugenisists..regardless of their apparent motivations..like cost...scratch the surface and see the roots of eugenics in the question"

Hello OUG, I never heard that word before. These are people in favour of others dying naturally or in favour of not medicating...?

I am watching three small souls have an arguement about a TV program, one wee one has stomped off, arms folded and bottom lip well out. One is sitting looking a bit sorry about the situation, the other is laughing at the display.

The sulky one is now pretending they don't care and are having a mountain of fun without the other two... nah one fell for it and has gone to join the fun. Ah and now the other one is up and three small souls are playing and giggling. Yep all that in the time it took to type slowly as I watched.

What has this to do with anything? Nuffink.[smile]

Dear Steven,

Today, patients can be
hooked up for days, months, or years to machines
that sustain their lives, and this step may be
taken even if they're in constant pain or even
if they are permanently comatose.

Thus, technologies and medicines that were intended to save
people from unnecessary death may actually have the
effect of depriving them of a dignified death.

As you point out Steven, terminally ill patients
can now be kept alive through medicines, artificial
respiration, intravenous feeding, electronic heart
stimulation, mechanical organ substitutes, or even
transplants of body parts from other people or animals.
Consequently, medical dilemmas can become moral and
legal ones as well.

'Life is sacred but is it worth US $300 a day?'
Let's weigh things up...

It's cost the taxpayers over $2 million dollars
in 2007-08, to maintain the lifestyles of
5 former Prime Ministers - (and that's not counting their
huge yearly pensions).
No one seems to question this expense.
Are the lives of ordinary ill taxpayers worth less?

Having said that, however -
It's a decision that should be made by the
patient themselves - what they desire (on the advice
of their medical professional),
and by those who love them most dearly.
Will the preservation of life help the patient?
And, is it desired by the patient and their family?
Those are questions that can only be answered by the people
involved.

Personally, I would only pursue a vigorous
therapy if it would benefit and help the terminally
ill patient. If the patient however -
had lost their functional and mental independence,
I would choose to let them die in peace and serenity.

However, Physicians are expected to do all they can to
sustain life, so I'm not sure how much say either I or
the family members would actually have in such a situation.
We may have to go along with whatever the hospital or the
specialist recommended.

You ask tough questions Steven.
I pray that neither of us will ever be placed in a situation
where we'll have to deal with them.

I'd like to know why it is that this drug costs so much. Given the huge profits made by Big Pharma, surely they could offset the R&D costs of such a drug against the squillions they make on all the other drugs they push.

Surely governments are in a position, via their regulation and oversight of health and medical services, to put a stop to this extortion?

I think you're asking the wrong questions about this issue, Steven.

You've read my mind CJ, I was going to say almost exactly what you said.

The issue here is NOT, I repeat NOT, whether or not we prolong the life of a stricken person.

The issue is - - - -

WHY DOES IT COST SO MUCH?

I bet it's because virtually EVERYONE along the chain, from the treatment's inception, testing and onto to it's final readiness for the patient GET THEIR CUT OF THE FINANCIAL REWARDS.

Yes, yes. I KNOW it's called "capitalism", but somewhere along the line comes the time when peoples' lives (if they want that extra six months of life) are more important than profits and ideology.

So far, it seems to me that nobody's willing to touch Steven's main point with a ten foot pole. The first few posts seem pretty irrelevant and sniping, Foxy makes some good points as usual, but can't answer this damn near impossible question, and CJ and Master raise another very interesting issue, but don't seem to tackle this one.

Regardless of whether we can make the pharmaceutical companies voluntarily reduce profits to make medicines and treatments more affordable, there are still going to be cutting-edge treatments that cost a fortune.

That's the crux of it. There are going to be treatments that can prolong people's lives, but they come at great cost and resources.

Pied Piper, I detect a dismissive, somewhat harsh tone there - but frankly, I think this is one of the most complex difficult issues we face as a society and dismissive moralising doesn't get us any closer to working through it.

Lets face it - we don't have unlimited resources. Sure, we can bark on about all the bad wasteful things that we as a society spend money on (we need to be pretty specific on what we're willing to cut spending on too).

As much as we'd like to however, we can't keep pouring money into treatments that extend the lives of people by a short while, if the cost is huge.

The fact is, it's a black hole. You could pour money into extending the lives of a massive proportion of the population. You could probably work through our entire GDP doing it, leaving us with nothing.

I'm not kidding. It really is Pandora's Box. The best thing we can do is try to make some sense of it and draw lines in certain places.

And this issue is pretty damn close to that line. In years to come, I suspect we're going to have to be even less humanitarian in drawing that line. I don't like that, but it's the reality of the situation.

*People who do keep themselves in good shape save taxpayer's money. Should they be rewarded with a $100 per year "wellness" bonus?*

Well that is actually not quite correct. For those people can live
into their 90s. That means 25years plus of pension payments, then
maybe another few years in a home with Alzheimers, not cheap either.

For the taxpayer, those who "enjoyed the good life" far too much
and have a good old heartattack at 65, are far far cheaper!

*Thus, technologies and medicines that were intended to save
people from unnecessary death may actually have the
effect of depriving them of a dignified death.*

Words of wisdom there Foxy, another gold star for you :)

*I'd like to know why it is that this drug costs so much.*

Quite simple. They will charge what the market will bear. For it
costs hundreds of millions of $, to develop a new drug that is
actually accepted, most new drugs go down the plughole of yet
another failure, for one reason or another. If a pharma company
puts a foot wrong, the lawyers will be waiting with multi mega
million $ lawsuits. Somebody has to pay for all that. The
field of biotech companies is littered with failures who got it
wrong, including in Australia.

You are of course free to put your hard earned savings into
biotech, to pay for the cost of testing some new wonder drug.
Most likely you will lose your shirt, its not for the faint hearted.

“Pied Piper, I detect a dismissive, somewhat harsh tone there - but frankly, I think this is one of the most complex difficult issues we face as a society and dismissive moralising doesn't get us any closer to working through it.
Lets face it - we don't have unlimited resources. Sure, we can bark on about all the bad wasteful things that we as a society spend money on (we need to be pretty specific on what we're willing to cut spending on too).
As much as we'd like to however, we can't keep pouring money into treatments that extend the lives of people by a short while, if the cost is huge.”

I was just being an arse really TRTL. My husband and I when discussing health insurance recently decided that we would become deathists (okay we aren’t that clever with labels), our theory was that if we get an illness that usually results in death we should just accept what nature throws at us, suck it up and die like good non excessive life consuming old people. Choose not to burden our tax paying children.

In reality we’ll probably run to the nearest doctor with a stubbed toe. At the time we thought the idea worthy of becoming an important stand for the natural order of things.

But your government does throw excessive money at everything, why not life?

Umm... my father in law died of cancer 48 hours ago and I feel weird about this conversation, please excuse irrational future outbursts.

No I wasn't close to him so it will be irrational.

sometimes, we cannot think like that, in the front of life, nothing is worthy or not, especially for the people involved, imagine if the patient is an important person for us, how could us make the decision. just like what foxy said. it is a tough question. may none of us will be placed in that situation.

OUG,

I am not going to bother to respond to your conspiracy theories. I think we all know there are not "hundreds of cancer cures".

TRTL, Thank you.

There will always be leading-edge expensive treatments, treatments that may prolong life but at very high cost.

Foxy,

I am not talking about PERSONAL DECISIONS. If the life of one of my children was at stake I would happily spend $600 or $3,000 per day to prolong life provided I could raise the cash.

But the real issue is this.

If you are the Minister of Health what is the maximum you would authorise Medicare to spend in order to prolong life by one year?

Such decisions need to be made. Resources are finite. Money spent on prolonging the life of one person is not available to, say, provide three or four other people with hip replacements.

So let me rephrase the question.

The British NHS will spend up to A$60,000 pa to prolong life.

What is the maximum Medicare should spend?

Let's have a number.

Yabby,

You are correct. On average FAT SMOKERS have the lowest lifetime healthcare costs. Governments that wanted to reduce healthcare costs should be promoting a smoke, drink, eat and be merry for tomorrow you save us megabucks lifestyle.

See: http://www.medscape.com/viewarticle/571715_3

If it weren't for PHILIP MORRIS and MCDONALDS we probably couldn't afford Medicare. Philip Morris actually tried to dissuade the Czech government from running an anti-smoking campaign on the grounds that it would cause an inflation of healthcare costs.

See:

http://www.mindfully.org/Industry/Philip-Morris-Czech.htm

In the US roughly 45% of LIFETIME HEALTHCARE COSTS are consumed by hospital and nursing home costs. Prescription drugs make up only about one sixth of the total. So it's not the EVIL PHARMACEUTICAL COMPANIES that cause most cost blow-outs.

See:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1361028&rendertype=table&id=tbl2

I'm guessing that roughly the same relative proportions apply in Australia.

Steven,
A few points you seem to have over looked.
Liver, kidney cancer often has little or nothing to do with excesses or the extent of ones abstemious lifestyle. Nor are 'fat' people created the same way or by the same consumption and/or activity level.
This of course ignores those with glandular, genetic or hormonal and other medical factors. Then there's the legal/moral and practical side of your proposed regime.
To discriminate in the way you suggest stimatising perhaps unfortunate at this stage of our medical where for all is inviting eugenics at worst and selfishly short sighted at best.

In the final analysis the question you pose comes down to "what is the value of someone else's life?". The value of a life is subjective to the person whose life it is or relationship to that person.
I think a better question would have been along the lines of CJ and master.

I would add when is enough profit enough

Would I be willing to pay $55,000 for an extra 6 months of quality of life? - YES.
Would I be willing to pay $55,000 for an extra 6 months of low quality life? - DEPENDS ON HOW LOW - But I would like the option of assisted suicide if what I was facing was months of pointless misery.
Would the fact that this is money affect how much my wife would have to live on when I die? MAY be a consideration in the low quality life case.
Different answers if what we are talking about is someone who would need medicare support to pay for it? - NO
Should I be doing things that will increase my years of low quality life? Better to die quickly from a heart attack while I am still enjoying life? - HMMM
Should I be taking medicine that reduces my current quality of life so that I will live long enough to die from dementia? - GOOD QUESTION
Should I be doing things that will increase the percentage of my life for which I am NOT a nett contributor? HMMM again.

Tricky set of questions.

"Should Medicare pay US$300 per day to prolong the life of a terminally ill cancer patient by 6 months?"
and: "What price limit should Medicare place on life-extending treatments?"

Should read:
Should Medicare pay US$300 per day to give life healing-treatment of a terminally ill cancer patient for 6 months?"
and:What price limit should Medicare place on natural life-healing treatments? (answer 2 this one:Until healed)

The question should be why we allow the pharmaceutical industry to make huge profits from our health problems.

The pharmaceutical industry is an investment industry driven by the profits of its shareholders. Improving human health is not the driving force of this industry..
http://www4.dr-rath-foundation.org/PHARMACEUTICAL_BUSINESS/laws_of_the_pharmaceutical_industry.htm

Since WWII, the pharmaceutical industry has steadily netted increasing profits to become the world's second largest manufacturing industry; after the arms industry.
http://www.sourcewatch.org/index.php?title=Pharmaceutical_industry

drug companies are spending more than twice as much on marketing, advertising, and administration than they do on research and development
http://www.actupny.org/reports/drugcosts.html

Many pharmaceutical companies enjoy greater profits as a
percent of revenue than other companies, even beating the
three top-ranked companies in the Fortune 500 list.
http://www.retiredamericans.org/ht/a/GetDocumentAction/i/3063

According to Declaration of Helsinki, “medical research is only justified if there is a reasonable likelihood that the populations in which the research is carried out stand to benefit from the results of the research.” drug companies are increasingly testing their new products on people from poor countries who will never benefit from them.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1071375

According to the Harris Poll, between 1997 and 2004 the percentage of adults believing that the pharmaceutical industry was adequately serving its customers declined from 79 percent to 44 percent.3 Less than 14 percent described pharmaceutical companies as “generally honest and trustworthy.”
http://www.cambridge.org/catalogue/catalogue.asp?isbn=9780521708883&ss=exc

Antonios Symeonakis
Adelaide

There are many natural (suppressed) treatments available, which are cheap and durable as far as life is concerned. If you get a doctor's death sentence, do NOT believe it, as for most doctors they don't know better. After all that is what they learn at uni.
There are too many examples in the world where it has shown that people were told "die within six months" who then turned around and healed themselves for good. Even the "gene factor" is mostly build on a fallacy. Do the research, I'd say, before the Net closes down on the info.
Did I hear somebody say "conspiracy theory"? Well, one should log into:
Alex Jones' http://infowars.tv or http://infowars.com

Examinator,

Even if we ran the most efficient healthcare system possible, cutting costs, and profits, to the bone there would always be case where a patient could only be kept alive at very high cost. The example quoted in the NY Times article is just that; an example.

There is, THERE HAS TO BE, a difference between the subjective value we place on our own lives and those of our loved ones, and the amount Medicare can spend on prolonging that life.

I place infinite value on the lives of my children. If the cost of saving either of their lives consumed Australia's entire healthcare budget for the next ten years I would consider it money well spent.

But would you be willing to see a decade's worth of healthcare expenditure devoted to saving the life of one person no matter what subjective value I place on their life?

Obviously not.

Therefore we need to set some sort of boundary. My question is this:

How much should Medicare be willing to spend to prolong life for one year?

You want to ask an equally valid but DIFFERENT question:

Are the pharmaceutical companies screwing us?

The short answer is "yes".

See:

http://www.mingbaima.com/2009/06/a-reply-to-peter-mansfield-of-healthy-skepticism-part-1/

http://www.mingbaima.com/2009/06/what-is-wrong-with-jupiter/

But resources are finite and we still need an answer to my question. Would you like to suggest a number?

John D

My grandfather, a heavy smoker, died of lung cancer. My aunt finally died after 10 years of Alzheimer's. Both are horrible ways to die but if I was compelled to choose I would take the cancer.

Reality Check:

On average prescription medications account for only about one sixth of lifetime healthcare costs. See:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1361028

So even reducing these to zero would do little to tame the seemingly inexorable rise in healthcare costs. The biggest villain is probably unnecessary procedures. See:

http://www.mingbaima.com/2009/07/the-most-dysfunctional-group-of-doctors-in-the-world/

*The question should be why we allow the pharmaceutical industry to make huge profits from our health problems.*

Antonious, Govts are free to put their billions of $ on the table
and pay for the development of new drugs. Its up to taxpayers really.

Given that Govts are not doing this, I'm happy to see investors
plough their money into these companies and take their chances.
If I might need what they discover, it will then be my choice.
I'd rather have that choice, then not have that choice.

SM, you ask a valid question and indeed, its one of these emotion-
reason dilemmas which we face, without easy answers.

Personally I think that age should have something to do with the
answer. These days, huge amounts of money are thrown at people
in their late 80s and 90s, anything to keep them alive for a little
bit longer.

A friend of mine in his late 80s, was involved in a severe car
smash and was a mess. He was in a bad way, in alot of pain and
pleaded with his doctors to lend him die with dignity and peace.
He decided that he'd had a great life, enough was now enough.
Despite his requests, they kept throwing resources at him, to
prolong his life for a few more days. All he really got was a lot
more suffering and a few more weeks, only to die anyhow.

Perhaps the patient's own choice, should come into significance a
little bit more, despite the Catholic Church preaching that it
is noble to suffer.

Dear Steven,

"Let's have a number?"

I assume that your premise is to balance the
provision of treatment with the money available to
Medicare. That public funding can't be a
bottomless pit.

I can't give you a number
because I'm not an expert in the field. How on earth
would I be capable of reaching a figure? How would I
do the calculations? They at best would be extremely
narrow - and probably misguided.

My concern is - we need to address the real needs of
suffering patients.
I'd like to know how are the figures reached?
And who does the calculations? What group approves
the drugs and are there experts in the field they
are evaluating?

By the way - I read that Sutent (also known as Sunitinib)
prolongs the survival not by 12 months but by 24 months.
And it does help ease the pain and suffering.

It is time these sort of decisions were debated in Parliament.
Surely the numbers involved are low and the overall cost
to Medicare wouldn't be that great compared with cheaper
drugs used for non-life threatening purposes by millions...

I have a mother-in-law - who was diagnosed with Alzheimers
a few years back. Her GP referred us (for her) to a specialist -
who prescribed the very expensive drug - Aricept for her.
This drug normally costs $300 a month, but with the referral
of a specialist - we're able to get it for her for $5.00 (approx).
The Government pays for it.

It's made a world of difference to her life - her condition
has not deteriorated for the past three years. It's not a
cure - but its given her a better quality of life. She still
recognizes us - and even though she has memory lapses - overall
I don't know where she would have been without the drug.

I'm sorry Steven - I can't put a price on the real needs
of suffering patients - it's up to the experts to decide
what drugs should be available on Medicare - and for whom.
I'm not one fo them.

Examinator: I was thinking about heart attacks vs alzheimers rather than cancer, however, having a cousin die of cancer with her mind intact vs my mother in law die of alzheimers I would tend to agree. Alzheimers has the added dificulty that it creeps up. If she had chosen to my cancer victim cousin could have made a rational decision about whether to continue treatment.

My mother in law could not have made that decision. Sure, she could have made a decision and left instructions but I have this vision of old people who suspect that their mind is going wandering around in fear that someone was going to act on the instruction. It is hard to decide what we are going to see as "the right time to die" when we are closer to what we thought the time should be. I remember when I thought that being fat and forty was over the fence.

stevenlmeyer,

You ask for a number. I think it is pointless providing you one. Sure, I have a number in mind, but it will be different everyone else, but I can't provide a good reason why mine should be chosen over anybody else's. I guess it all hinges on how much value you put on a human life, and that is a personal thing.

Between us we have already come to some sort of muddled compromise via our political system. The way we arrived at it may not be perfect, but it seems to be a number most of us can live with. Since ultimately that is what matters most - that we all go peacefully along with that single measure of how much effort a government must put into preserving our life, in effect making the final determination on when we die. There is more justification for that particular number than any I could offer for mine.

Your link to FAT SMOKERS being the cheapest to support was great. I always wondered about that.

Dear Belly,
Are you happy with the way of the world. Trouble, strife, poverty, division, sickness, stress, drugs, coruption, greed, polution, mismamagment and the like. Religious strife and other mindsets all leading from dead mindsets. Ideas of dead men.
I am not and as I know the road to paradise, I will shout it from the rooftops. Jesus is Alive follow him not ideas of dead men. Behind almost all good ideas is somebody with a lust for money and power kingdom, building for this world and that is what is the problem.
When you have a better answer than Jesus gives, I might choose to listen. While trouble and strife is the only fruit of your world don't expect me to partake. I will be off line for some time for medical reasons so God bless and may love, joy, and peace be the order of your day. I have missed you old friend.

Steven and others
Thanks for your response.
I see your reasoning and agree a more efficient Medicare is desirable .
But putting a limit to expenditure overall and/or classes of patients isn't the answer.

As a rule I bang on about two issues...context and objectivity.

The differences in systems are such that comparisons are tenuous at best. Big Pharma and Commercial interests have far more influence.
Commercial media is hardly an absolute or objective quotable analytical source (Aus too)as they tend to focus on the sensational therefore by definition the exceptions rather than the rule.

Secondly . My point is here that if one examines the major expenditure types in the Medicare budgets the line items like you identify are small beer by comparison to other expenditures "inefficiencies and commercial manipulations".
i.e. 83 yo-ish neighbours are gold card recipients. Free private hospital/specialists They take take over 15 different medications daily. Many GCers *tend* to be obese, lifetime smokers and heavy drinkers etc. Collectively they cost FAR more than the those who are on the expensive drug you mention and for much longer periods of time. Then there's their own govt. dept. Soylent green ?

Discussions like this tend to forget that health care is funded under the principal of aggregation... simply put, by charging eveyONE a little no ONE need die or suffer unnecessarily for the want of money.
Socialised medicine? Hardly it's simply the same principal of banks and insurance without the profit rake off motive.

My initial concern is that how do you define WHO is worth spending money on without placing a $ value on a life...(variant form of eugenics).

This of course does not exclude striving for efficiencies (elimination of waste and search for better and/or cheaper solutions). More basic research makes sense. Likewise forcing Big Pharma prices to reflect govt. financed uni research.

Finally I find discussions that avoid the the systemic problems and focusing on the symptoms disturbing especially when it comes from intelligent people (as opposed to the general self interested, "instant answer" bulk of population(talk back radio mentality).

Dear Richie 10,

I wish you well with your medical problems.
May they all be solved successfully and well.
'The uncertainty that darkness brings
can humble even the hardest soul.'

Take care, and our thoughts and prayers go with you.

Examinator: “Liver, kidney cancer often has little or nothing to do with excesses or the extent of ones abstemious lifestyle.”

My father in law was hard working, physically fit and slim his whole life... died of cancer in the liver and pancreas on Friday. No special new drug offered. Father of children died two years ago at 40 years old of bladder cancer, he was slim too. Based on my personal experience I’m starting to think about eating more and doing less.

“Finally I find discussions that avoid the systemic problems and focusing on the symptoms disturbing especially when it comes from intelligent people (as opposed to the general self interested, "instant answer" bulk of population(talk back radio mentality).”

It is hard to stay up to date with all the systemic problems. How do you all do it? Does medical insurance come in to this as well?

As a healthcare worker for many years, I can say that no two cases of life-threatening illnesses of any kind are the same. There are many other variables to consider when deciding on the merits or otherwise of treatments for prolonging life.

Age, comorbidities (other illnesses), gender, race, social situations, economic situations,geographical location, and last, but not least, the quality of life likely after treatment as opposed to before treatment. Often these treatments involve decreasing the pain or discomfort of the disease process, even if only for a few months.

I believe we will be travelling a very slippery moral and ethical slope if the Health Department ever decides to make blanket statements about any drug cost as opposed to prolonging a productive,
much wanted life for a little longer.

Suzeonline

On Q&A last one of the panellists, Dr. Charlie Teo, a neurosurgeon, made the following comment. (I am quoting from memory)

"We should tell the public that Medicare just can't do what they expect it to do."

See:
http://www.abc.net.au/tv/qanda/txt/s2622519.htm

I think Dr. Teo should be commended for pointing out a REALITY that anyone with half a brain understands. NO public system can provide the level of healthcare that a wealthy man can purchase for himself. That means that there will be cases where a wealthy man can access life-extending treatment that is not available to less well-off people.

To put it bluntly, there will ALWAYS be life-extending treatments that will be denied people who rely solely on Medicare. Sometimes wealthy people will be able to buy themselves an extra year or so of life. No reforms, no economy measures, no FEASIBLE level of healthcare funding CAN alter that fact.

I think it time the politicians came clean with the public. We need a debate. What can Medicare do and what can't it do? Where are the limits? And yes there are going to be cases where terminally ill patients are going to be denied life-extending treatment because it is just too expensive. That issue CANNOT be wished away.

An interesting discussion.

There are some general issues:

>>To put it bluntly, there will ALWAYS be life-extending treatments that will be denied people who rely solely on Medicare.<<

And some specific points:

>>I think it time the politicians came clean with the public. We need a debate. What can Medicare do and what can't it do? Where are the limits?<<

I would suggest, stevenlmeyer, that the very nature of the responses on this thread clearly show that there is no point debating the value of a human life.

The individual in question, the parents, the next-door neighbour, relatives, friends, acquaintances, people in other towns and countries who have never met the person, will all have a different view of how much that person is "worth".

But "defining the limits" is certainly valid.

The most appropriate approach would be for the government to pretend to be an insurance company, and state an upper limit to claims on the "virtual policy" that is funded by the taxpayer.

But you should not expect them to justify it in any way. It would be a cold, calculated amount, that takes into account supply (the allocation of taxpayers' funds, the proportion of which should be clear government policy) and demand, which is the cost of treatment available.

There's also no point in castigating "Big Pharma" on this. The fastest way to limit R&D in this area is to try to manage their pricing policies. As it is, the most lucrative area in the business is generics, where companies take advantage of lapsing patents to churn out lower-cost clones. Their contribution to new treatments and drugs? nil.

But the "value" of human life?

Purely personal.

It ranges from zero, as with the oldie Yabby tells us about, to infinity: what mother wouldn't sell everything she had for another day with her child?

Theoretically, insurance should be the answer. Unfortunately, the act of using "other people's money" encourages all sorts of appalling behaviour, both on the supply and demand sides. The US experience of this is salutary.

It wouldn't be a bad place to start, though.

stevenlmeyer: "I think Dr. Teo should be commended for pointing out a REALITY that anyone with half a brain understands."

I think pointing out the obvious is an exercise best let to the talking heads who are paid to entertain the masses.

stevenlmeyer: "We need a debate."

We need to debate the obvious? Surely not.

Yet again Pericles,
Has put the cherry on the top with his usual impeccable logic.
WHAT steven and rstuart fail to understand with their perjorative 'any one with half a brain ' comment is that there is a big difference between being told something andbeing able to emotionally accept visa vie AGW.
In addition to this there is always other alternatives.
My concern is not for short term temporary extention of life of say the very elderly but for the life of say of a AIDS sufferer there there is a cocktail of expensive drugs for protracted period of time. To deny these people the drugs based on wealth issues to me is obscene.
My final point is that the current health systems can be be improved by implementing a change of ethos.

Pied piper,
My condolances. I too lost an aunt at 43 from lung and liver cancer. She was a vego who never smoked or drank and highly religious.
As I said there are more than fatness etc as factors.

examinator: "there is a big difference between being told something andbeing able to emotionally accept visa vie AGW."

Eh? What are you saying?

Whether someone chooses to emotionally accept a fact is their business. Not only do I not think it isn't my responsibility to ensure they accept it, I think trying to force them to do so is downright wrong. Ye Gods. I enough trouble with the runner's of this world insisting I emotionally accept some facts that are bleedingly obvious to them, without you joining their club.

Examinator

Nobody is saying that only fat people get heart attacks or that only smokers get lung cancer. All we can say is that if you control your weight, eat sensibly, stay fit, refrain from smoking or abusing alcohol you decrease the RISK of getting these diseases. What is more the decrease in risk is substantial.

But there are no guarantees. You may do all these things and get a stroke today.

My understanding is that in Australia HIV infected people do get the cocktail of drugs needed to keep them alive.

Imagine that a new anti-retroviral comes on the market. It prolongs life indefinitely. People who take the new drug never get full-blown AIDS. When they do die they die of something else.

The new drug costs $2mn pa.

You say it ought not to cost that much, that the manufacturers are scumbags who should make it available at a reasonable price. But that is the price they set. They tell Medicare "take it or leave it".

What should Medicare do?

Pericles

In effect the government is providing a sort of insurance policy. Insurance polices have to have limits.

But there will ALWAYS be borderline cases. There will always be instances in which it is not clear whether the "policy" covers some new treatment.

Pericles, Examinator

If the life of one of my children were at stake I would be arguing for exceptions; NO sum would be too high to extend their lives. Never mind $2 mn per year. I would regard $100 mn per year as cheap at the price.

Nobody could expect me to be unbiased in such a case which is why I should NOT be allowed to be the decision-maker if the life of one of my children was at stake.

That is why we need rules set out in advance and administrators who apply them impartially. That is also why the rules need to be as clear and unambiguous as is humanly possible. And, yes, the rules do need to consider cash limits and cost-effectiveness within the context of Medicare's budget limitations.

*You say it ought not to cost that much, that the manufacturers are scumbags who should make it available at a reasonable price. But that is the price they set. They tell Medicare "take it or leave it".
What should Medicare do?*

This is where our Govt subsidised pharma scheme, is in fact a great
advantage. Drug manufacturers are not silly, they price their products
according to what each market will bear. Huge margins on no sales
is not profitable, especially since all of these drugs have only
so many years to get their money back, before they become off patent.

So there are large variations between countries, in drug pricing.

I gather that our scheme has some way of deciding how much a drug
costs, versus the benefits it actualy provides. If its too expensive,
it won't be subsidised, which means virtually no sales.

This keeps the price of drugs in Australia at some realistic
level, for if manufacturers charge too much, they won't sell any.

Sounds like you've arrived at an answer, stevenlmeyer.

>>...the rules need to be as clear and unambiguous as is humanly possible. And, yes, the rules do need to consider cash limits and cost-effectiveness within the context of Medicare's budget limitations.<<

One of the rules might be a solid definition of a "life-ending", as against merely "life-threatening", disease. Each would, I suspect, need to have upper limits imposed on dollar value and timeframe - along the lines $x a day for y months.

You might also find that with these rules in place, private insurance companies would offer a top-up policy, which would allow you to extend treatment for a defined period.

That would allow you to anticipate a situation where...

>>NO sum would be too high to extend [my children's] lives. Never mind $2 mn per year. I would regard $100 mn per year as cheap at the price.<<

And you could put your money where your mouth is, ahead of time, for a few bob a day.

Individuals and government needlessly waste health resources because their decisions are not evidence-based.

Reason and evidence prevented the wasteful wholesale screening of men for prostate cancer - the cost/benefit just wasn't there although the decision meant that some men who could have been saved would die. Maybe the argument for routine breast mammography for breast cancer is similarly flawed, but who would know with the amount of pink politics involved?

The problem for government is that terms are short and oppositions focus on opposing policy rather than on presenting a viable alternative.

New drugs and treatments
There would be few advances without the availability of venture capital. Risk requires adequate reward, otherwise the investment money goes elsewhere.

Looking at the bottom line and trying to move backwards to develop policy with restrictions and bans might suit economists but it is like trying to rearrange the porcelain with a crow bar.

Steven,
We agree (with qualifications) that
Some people have a higher genetic potential for cancer others and it doesn't depend necessarily on weight or lifestyle. There are many factors that cause weight issues doesn't necessarily mean unhealthy. All this was in response to your suggestion of rewards program to draw attention to the the question who do you 'reward' or 'punish'? My observations went on to raise the 'whole of community' funding. Also to put perspective on your stated concerns. As Dr Teo said on Q&A '80% of our medical costs occur in our latter lives.'
I also said that too many entrepreneurs are injecting themselves into the system each with their demand for POTA.(piece of the action), reducing the available funds to be spent *on the needy*. ( too many "drinkers at the well").
I agree with Pericles about insurance but I see no real reason why this needs to be in private hands (ideology and self interest aside). BUT THAT IS ANOTHER TOPIC.

Yes HIV drugs are subsidised but can be more exy that the ones you cited.

But as I said Pericles nailed the issue.

YABBY
If only what you suggest about the PBS were true. One needs to consider 'me too' (left or right molecule change can in effect increase the prohibition on the parent drug too. Then there are 'new' drugs that don't really do any better but are more expensive. Not to mention the way drugs are cleared is open to manipulation. This end of 'big' is a pit of vipers much like 'life science'(GM ) corps. skulduggery.

RStuart
my comment had nothing to do with your responsibility save a bit of perspective. My point was that common opinion has little to do with reason and facts and more about belief therefore the half a brain comment/attitude was inappropriate. What may be obvious to us including the (non)existence of God is not to others ….therefore a reasoned debate and time changes opinions.

Examinator

I am not proposing to "punish" anyone.

Most overweight or obese Australians do not get that way because of some genetic factor. Their bulk is USUALLY, not always but USUALLY, due to a combination of eating too much of the wrong kinds of food and a lack of exercise.

Similarly lack of cardiac fitness is USUALLY due to a sedentary lifestyle rather than genes.

All I'm proposing is FUN way of getting the message across. Exercise more, eat more of the right kinds of food and shed a few excess kilos. The $100 reward is purely nominal.

So lighten up examinator

Steven
I think you're over interpret my motives.
I am relaxed....I was just examining what you said.
You're right many of the over weight is as you say.
My problem with many conversations is that proposers of topics tend to think in therms of absolutes...black and white. While by no means a genius or uniquely insightful I do try to ground topics in terms of wider perspectives.
I.e. the exceptions tend to distort the rules. :-)

Why not extend the argument a little and penalise women who abort children thus contributing to an expensive immigration program (and no I am not opposed to abortion)? Easy to do, just remove any contribution by the taxpayer.

Alternatively those who abort a defective feotus determined by a scan ought be rewarded with at least a $1000 bonus - the savings to the health and education systems alone are enormous.

All people who don't ride motorbikes should get $100 pa for sure and then there are those who are over 55 and don't figure in those expensive injury claims from car accidents, give them a bonus too.

A few hundred a year is cheap for heterosexual non-drug users. Sign the Stat Dec, pee in this and if clear take the money.

Pay migrants a few thou for every year they put off bringing their aged or disabled relatives in under the family reunion scheme. Better still, ban family reunion.

I am not fat and I have a remarkable healthy body - thanks parents - but I am damned if I am going along with the game of find a whipping boy to blame for the faults of the health system and the abject failure of successive governments to plan and manage an effective, efficient health service.
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What about the intergenerational jealousy and blaming that has gone on about older people, especially boomers, for the alleged lack of cheap housing for spendthrift gen Y's? That is what this is all about isn't it, the game of find and label the whipping boy that is so popular with lazy, cynical politicians and the tabloid press? The same argument is used to flog smokers for some more taxes and no, I don't smoke either.

Anyhow, this brings me to the Number 1 way of saving money for smug young professionals who have better things to do with their money than pay tax 'to support others', which is free suicide pills in outpatient and emergency care units for all who do not meet approved standards. Nothing like saving some tax dollars and speeding up the transfer of all of those assets.

My doctor friends told me I would be opposed to voluntary euthanasia if I saw what they see and they are probably right - ve haf simple ways of encouraging people to save ze health dollars, starting with some sledging of fatties.