I’ve got your rationing right here

Earlier this week, the indispensable Megan McArdle was writing about the difference between US and European health care:

What America is best at is delivering a lot of complicated care in extremis, and “quality of life” treatments. What European countries are best at is delivering a lot of ordinary care for the sorts of things that afflict people from 0-50, which is why most of the Europhile journalists writing about Europe genuinely have very good experiences to report. I’d rather be here to have a hip replacement, but I might rather be in the Netherlands to have a baby. Doing something moderately ordinary here is a hassle. Doing something extraordinary there is often not possible for the overwhelming majority of citizens, though that depends on what, and in what system.

McArdle tries to be measured in her remarks (you can tell she used to write for the Economist), but it’s still too much for Kevin Drum. Writing for Mother Jones (sigh), Drum says he doesn’t believe US health care is better for anything, except maybe for 0.001% events.

So McArdle takes Drum to school with the story of Herceptin, an effective drug for 1 in 4 breast cancers (that’s four, count ’em, four orders of magnitude greater than Drum’s guess) that was banned in Britain. A British woman successfully sued for access to the drug, but too late to save her life.

I’ll add to that a Wall Street Journal article on the British NICE agency. NICE keeps costs down the only way it can, through rationing:

NICE currently holds that, except in unusual cases, Britain cannot afford to spend more than about $22,000 to extend a life by six months. Why $22,000? It seems to be arbitrary, calculated mainly based on how much the government wants to spend on health care. That figure has remained fairly constant since NICE was established and doesn’t adjust for either overall or medical inflation.

The article chronicles many cases of NICE’s rationing: denying pap smears to young women, denying effective drugs for breast cancer, stomach cancer, arthritis, and multiple sclerosis, and denying procedures for back pain. Two of NICE’s cruelest rulings are for macular degeneration and Alzheimer’s:

In 2007, the board restricted access to two drugs for macular degeneration, a cause of blindness. The drug Macugen was blocked outright. The other, Lucentis, was limited to a particular category of individuals with the disease, restricting it to about one in five sufferers. Even then, the drug was only approved for use in one eye, meaning those lucky enough to get it would still go blind in the other. As Andrew Dillon, the chief executive of NICE, explained at the time: “When treatments are very expensive, we have to use them where they give the most benefit to patients.”

NICE has limited the use of Alzheimer’s drugs, including Aricept, for patients in the early stages of the disease. Doctors in the U.K. argued vociferously that the most effective way to slow the progress of the disease is to give drugs at the first sign of dementia. NICE ruled the drugs were not “cost effective” in early stages.

That’s the British health system for you: go blind in one eye and be thankful for it, and too bad about that dementia.

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