Medicare Breaks the Bank - Again

Serengeti, Tanzania - photo by JoAnn Sturman

by Scott Sturman

The nearly complete disconnect between cost and demand is the primary reason Medicare is broke.  A surgical colleague shared a story which illustrates the problem. 

Provenge is a FDA approved vaccine used in the treatment of advanced, metastatic prostate cancer.  The drug costs $93,000 and in clinical studies extended life expectancy from 21 to 25 months - a mere four months.

A company representative visited the surgeon at his office and encouraged him to use the product.  A gist of the conversation follows:

“Why should I prescribed Provenge for my patients?”

“It increases life expectancy 20% for patients with advanced prostate cancer.”

“Prostate cancer is an indolent process.  A 20% increase in life expectancy from initiation of treatment sounds impressive, but actually it’s only four months.  It’s a small benefit for a lot of money.”

“The cost is not a problem; Medicare pays every cent.”

“Nearly $25,000 per month for four months seems exorbitant.  Besides, the last four months of life with metastatic prostate cancer are miserable; the patient is generally bed ridden and requires high doses of narcotics to manage the pain.” 

“Imagine what the public would think, doctor, if the newspaper reported your unwillingness to help dying patients in your care from spending a few more months with their loved ones.”

If the cost benefit ratio is unreasonable, then the threat of  exposure to the media as a heartless physician who knowingly deprives his patients of all available treatments may be the most convincing sales strategy.

The surgeon was curious how his patients with advanced metastatic prostate cancer felt about a cancer vaccine.  After explaining the risks and benefits of the treatment, he informed them the drug costs $93,000.

“No way I’m going to pay that kind of money for maybe four extra months, doc.”

“I thought you’d say that, but the drug costs you nothing.  Medicare pays the entire bill.”

“Well ... in that case.”

“Let me ask you another question, while we are on the subject of finances.  If I offered you the choice of $20,000 in cash now or the $93,000 cancer vaccine free of charge, which one would you take?”

“I’d take the $20,000, doc.”

“That’s what everybody else said.  We could save Medicare $73,000, if they would just pony up the cash, and you would forego treatment.”

Vast sums of money are wasted in the Medicare program. Rather than proposing Health Savings Accounts and similar programs which restore financial accountability, ObamaCare regulations undermine them.  As long as there is no link between the specific service and its expense, massive cost overruns and eventual rationing of care are inevitable.