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Oncologists Call for Single-Payer System
Oncologists Call for Single-Payer System
Oncologists have a "moral and ethical obligation" to their patients to advocate for a single-payer universal health insurance program, according to two oncologists who stated their case in an editorial.
A single-payer system would simplify healthcare delivery for patients and providers without sacrificing quality of care, said Ray Drasga, MD, and Lawrence Einhorn, MD, in an editorial published online in the Journal of Oncology Practice, a journal of the American Society of Clinical Oncology.
The switch to such a national system would face huge and innumerable challenges, but gradual implementation, perhaps even on a state-by-state basis, would reduce the administrative burdens, they wrote.
"Because the [Affordable Care Act or ACA] will fail to remedy the problems of the uninsured, the underinsured, rising costs, and growing corporate control over care giving, we cannot in good conscience stand by and remain silent," said Drasga, a retired oncologist in Chicago, and Einhorn, of Indiana University in Indianapolis.
"Life is short, especially for some patients with cancer; they need help now."
Making Their Case
Drasga and Einhorn state their case for a single-payer system by delineating problems that such a system could address:
Reduced administrative costs, which currently account for almost a third of healthcare expenditures
Eliminating many bankruptcies attributable to healthcare costs, which accounted for more than 60% of family bankruptcies identified in a 2009 report
Improved health, as indicated by evidence that being uninsured increases the mortality hazard by 40%
Building on an existing structure, noting that about 60% of all healthcare in the U.S. is publicly funded
Implementation of proven cost-containment strategies, which are absent from the ACA
Improving quality of care and outcomes by increasing access to care
Reverse the trend toward for-profit, investor-owned healthcare plans
Preserve physician's income potential, as judged by experience with the Canadian healthcare system
The authors devoted special attention to the cost of drugs and devices. They cited a study showing that pharmaceutical companies charge 50% more in the U.S. than in Europe for the same drugs. Much of the difference can be traced to large outlays for marketing and for a 20% profit margin, they said. By comparison, research and development (R&D) accounts for about 13% of drug costs.
The Department of Veterans Affairs gets a 40% discount on medication by buying in bulk. Medicare is legally forbidden to negotiate drug prices.
"Lower drug prices would not jeopardize drug innovation," Drasga and Einhorn stated. "Most true innovations in therapeutics (as opposed to me-too drugs that are slightly different versions of existing drugs) stem from publicly financed research."
The issue of drug pricing is especially relevant to oncology, they added, where the median cost of a new drug has risen to $10,000 a month since 2010.
The authors called on ASCO to lead the way in advocating for a single-payer system, which would orient healthcare "toward care giving, not toward maximizing investors' profits."
ASCO has taken no position on a single-payer or other type of healthcare system, said ASCO chief executive officer Allen Lichter, MD.
"We have long advocated that every American deserves to have insurance coverage," Lichter told MedPage Today. "We have advocated that those patients who receive a new cancer diagnosis and don't have insurance should be placed into Medicare because facing a cancer diagnosis without insurance lowers your risk of survival, as Dr. Drasga and Dr. Einhorn pointed out in their paper."
Payment Reform
Coinciding with the Drasga-Einhorn editorial, ASCO and the Community Oncology Alliance (COA) jointly issued principles for achieving payment reform in oncology.
The six principles focus on:
Oncologists taking a leadership role in payment reform
The inadequacy of current reimbursement models
The need for new models for delivering oncology services to ensure high quality and value
Retaining choices in payment models at the local level
Improved measurement of quality
The inadequacy and inequity of reimbursement for oncology drugs under Medicare Part B
The editorial provides "a good look at Nirvana," but most community-based oncologists would find it difficult to embrace, said Mark Thompson, MD, president of the COA, which represents community oncology practices and centers.
"You can't dispute a lot of the facts that they lay out in the article," said Thompson, who practices at the Mark H. Zangmeister Center in Columbus, Ohio. "We do spend a huge amount of money in administering healthcare in the U.S.
"The difficulty that most of us who have spent any time in Washington -- and I've spent a lot of time there -- is the idea of making this public, which to me translates into government. I don't think we have a government or a Medicare program that can handle all of the wonderful suggestions that they talk about."
To the arguments against government-run programs, Drasga and Einhorn countered that "years of private-sector solutions have failed. There needs to be a major paradigm shift in our approach to funding healthcare in the U.S."
Strong opposition to a single-payer system is to be expected because a lot of money is at stake, Drasga told MedPage Today. Several academic oncologists turned down Derasga's offer of co-authorship before Einhorn accepted.
"I think they were afraid that it might hurt their relationship with pharma," he said. "A lot of research is funded by the pharmaceutical industry. There are a lot of powerful forces that do not want to see something like socialized insurance come along."
Nirvana or not, the single-payer approach is coming, Derasga continued. Vermont has set the process in motion by starting implementation of a state-run single-payer system. Total implementation is anticipated by 2017.
"Once one or two states get programs in place and see that they can save millions and millions of dollars, plus insure everybody, I think we could see a snowball effect," he said.
The Vermont program is envisioned as “kind of a Medicare for all, but at the state level,” said Deb Richter, MD, a primary care physician from Montpelier who is chair of the advocacy group Vermont Health Care for All.
Officials at Green Mountain Care, the organization in charge of implementing the single-payer system, still have to jump through a lot of legislative and bureaucratic hoops (including waivers from the ACA and Medicare), but they remain optimistic the plan will be fully operational by 2017. The waivers could provide a portion of the funding for system, but the state still has to come up with extra revenue, currently estimated at $1.6 to $2 billion.
The Green Mountain board will submit revenue options to the state legislature in March.
When fully implemented, the plan will leave little business for private insurers, Richter said. The state plans to accept bids for administration of the system, but the market for private insurers will be limited to Vermonters who opt out of the state-run plan.
Whether support for a single-payer system catches fire remains to be seen, but reaction to the Derasga-Einhorn editorial has been limited thus far in the week-plus since the online article appeared, said journal editor John Cox, DO, of Texas Oncology in Dallas.
"The intention was to stir the pot the little, and I suspect we will because this is an issue that has a lot of strong feelings on both sides," Cox told MedPage Today.
http://www.medpagetoday.com/HematologyOncology/OtherCancers/44034
Oncologists have a "moral and ethical obligation" to their patients to advocate for a single-payer universal health insurance program, according to two oncologists who stated their case in an editorial.
A single-payer system would simplify healthcare delivery for patients and providers without sacrificing quality of care, said Ray Drasga, MD, and Lawrence Einhorn, MD, in an editorial published online in the Journal of Oncology Practice, a journal of the American Society of Clinical Oncology.
The switch to such a national system would face huge and innumerable challenges, but gradual implementation, perhaps even on a state-by-state basis, would reduce the administrative burdens, they wrote.
"Because the [Affordable Care Act or ACA] will fail to remedy the problems of the uninsured, the underinsured, rising costs, and growing corporate control over care giving, we cannot in good conscience stand by and remain silent," said Drasga, a retired oncologist in Chicago, and Einhorn, of Indiana University in Indianapolis.
"Life is short, especially for some patients with cancer; they need help now."
Making Their Case
Drasga and Einhorn state their case for a single-payer system by delineating problems that such a system could address:
Reduced administrative costs, which currently account for almost a third of healthcare expenditures
Eliminating many bankruptcies attributable to healthcare costs, which accounted for more than 60% of family bankruptcies identified in a 2009 report
Improved health, as indicated by evidence that being uninsured increases the mortality hazard by 40%
Building on an existing structure, noting that about 60% of all healthcare in the U.S. is publicly funded
Implementation of proven cost-containment strategies, which are absent from the ACA
Improving quality of care and outcomes by increasing access to care
Reverse the trend toward for-profit, investor-owned healthcare plans
Preserve physician's income potential, as judged by experience with the Canadian healthcare system
The authors devoted special attention to the cost of drugs and devices. They cited a study showing that pharmaceutical companies charge 50% more in the U.S. than in Europe for the same drugs. Much of the difference can be traced to large outlays for marketing and for a 20% profit margin, they said. By comparison, research and development (R&D) accounts for about 13% of drug costs.
The Department of Veterans Affairs gets a 40% discount on medication by buying in bulk. Medicare is legally forbidden to negotiate drug prices.
"Lower drug prices would not jeopardize drug innovation," Drasga and Einhorn stated. "Most true innovations in therapeutics (as opposed to me-too drugs that are slightly different versions of existing drugs) stem from publicly financed research."
The issue of drug pricing is especially relevant to oncology, they added, where the median cost of a new drug has risen to $10,000 a month since 2010.
The authors called on ASCO to lead the way in advocating for a single-payer system, which would orient healthcare "toward care giving, not toward maximizing investors' profits."
ASCO has taken no position on a single-payer or other type of healthcare system, said ASCO chief executive officer Allen Lichter, MD.
"We have long advocated that every American deserves to have insurance coverage," Lichter told MedPage Today. "We have advocated that those patients who receive a new cancer diagnosis and don't have insurance should be placed into Medicare because facing a cancer diagnosis without insurance lowers your risk of survival, as Dr. Drasga and Dr. Einhorn pointed out in their paper."
Payment Reform
Coinciding with the Drasga-Einhorn editorial, ASCO and the Community Oncology Alliance (COA) jointly issued principles for achieving payment reform in oncology.
The six principles focus on:
Oncologists taking a leadership role in payment reform
The inadequacy of current reimbursement models
The need for new models for delivering oncology services to ensure high quality and value
Retaining choices in payment models at the local level
Improved measurement of quality
The inadequacy and inequity of reimbursement for oncology drugs under Medicare Part B
The editorial provides "a good look at Nirvana," but most community-based oncologists would find it difficult to embrace, said Mark Thompson, MD, president of the COA, which represents community oncology practices and centers.
"You can't dispute a lot of the facts that they lay out in the article," said Thompson, who practices at the Mark H. Zangmeister Center in Columbus, Ohio. "We do spend a huge amount of money in administering healthcare in the U.S.
"The difficulty that most of us who have spent any time in Washington -- and I've spent a lot of time there -- is the idea of making this public, which to me translates into government. I don't think we have a government or a Medicare program that can handle all of the wonderful suggestions that they talk about."
To the arguments against government-run programs, Drasga and Einhorn countered that "years of private-sector solutions have failed. There needs to be a major paradigm shift in our approach to funding healthcare in the U.S."
Strong opposition to a single-payer system is to be expected because a lot of money is at stake, Drasga told MedPage Today. Several academic oncologists turned down Derasga's offer of co-authorship before Einhorn accepted.
"I think they were afraid that it might hurt their relationship with pharma," he said. "A lot of research is funded by the pharmaceutical industry. There are a lot of powerful forces that do not want to see something like socialized insurance come along."
Nirvana or not, the single-payer approach is coming, Derasga continued. Vermont has set the process in motion by starting implementation of a state-run single-payer system. Total implementation is anticipated by 2017.
"Once one or two states get programs in place and see that they can save millions and millions of dollars, plus insure everybody, I think we could see a snowball effect," he said.
The Vermont program is envisioned as “kind of a Medicare for all, but at the state level,” said Deb Richter, MD, a primary care physician from Montpelier who is chair of the advocacy group Vermont Health Care for All.
Officials at Green Mountain Care, the organization in charge of implementing the single-payer system, still have to jump through a lot of legislative and bureaucratic hoops (including waivers from the ACA and Medicare), but they remain optimistic the plan will be fully operational by 2017. The waivers could provide a portion of the funding for system, but the state still has to come up with extra revenue, currently estimated at $1.6 to $2 billion.
The Green Mountain board will submit revenue options to the state legislature in March.
When fully implemented, the plan will leave little business for private insurers, Richter said. The state plans to accept bids for administration of the system, but the market for private insurers will be limited to Vermonters who opt out of the state-run plan.
Whether support for a single-payer system catches fire remains to be seen, but reaction to the Derasga-Einhorn editorial has been limited thus far in the week-plus since the online article appeared, said journal editor John Cox, DO, of Texas Oncology in Dallas.
"The intention was to stir the pot the little, and I suspect we will because this is an issue that has a lot of strong feelings on both sides," Cox told MedPage Today.
http://www.medpagetoday.com/HematologyOncology/OtherCancers/44034
" health costs may have slowed but will continue to rise until we meet the challenge head on,"
This is what scares me. It took this long to try to make a change and one of the flaws with the program is that the cost of health care as a whole continues to rise.... How long before we address that?
With just about everything our government does, I wish they'd spend a little more time on things before subjecting the general populace to these things, ruin a few lives on the way and then begin discussions that often take decades to fully play out.... except they don't really play out and someone ends up thinking things are getting jammed down their throats.
We can do better. Why we don't try is beyond me.
This is what scares me. It took this long to try to make a change and one of the flaws with the program is that the cost of health care as a whole continues to rise.... How long before we address that?
With just about everything our government does, I wish they'd spend a little more time on things before subjecting the general populace to these things, ruin a few lives on the way and then begin discussions that often take decades to fully play out.... except they don't really play out and someone ends up thinking things are getting jammed down their throats.
We can do better. Why we don't try is beyond me.
Yes, I am an optimist and it will probably be my end for being so, but it makes alot more sense than all this pessimism we been living with. If we were wearing rose colored glasses, it would end in doing nothing at all to change the so called greatest health care in the world. Not!
"Im sure that we could figure out a fair and balanced way of implementing it"'
I'll give you one thing, you're an optimist. Myself, I have a dog in the fight (VT) so I put away the rose colored glasses some time ago.
I'll give you one thing, you're an optimist. Myself, I have a dog in the fight (VT) so I put away the rose colored glasses some time ago.
It is my understanding that there are multiple ways of doing it. Im sure that we could figure out a fair and balanced way of implementing it. Regardless, even with the ACA, health costs may have slowed but will continue to rise until we meet the challenge head on, this is why I am all for single payor, simply because the path we are on is unsustainable in the long term.
"Im all about single payor" How do you propose to pay for single payor healthcare? 15% extra federal income tax?
My preference would be a new federal sales tax on everything. Everyone would then be subject to paying the piper. Higher earners are higher consumers, thus would pay more. Lower earners ,less consumption, thus less taxed. Seems fair enough.
My preference would be a new federal sales tax on everything. Everyone would then be subject to paying the piper. Higher earners are higher consumers, thus would pay more. Lower earners ,less consumption, thus less taxed. Seems fair enough.
Yes! Finding common ground . . . even if it is just to say I disagree with you and agree to disagree is a feel good moment!
And really, I have mixed feelings about some things regarding this subject. I don't want anyone to suffer Teko or go broke trying to stay healthy.
I mean . . . I've got a heart in there somewhere.
I just can't imagine this debacle of govt. being involved in something so precious as healthcare. I can't imagine how they would mess it up as you see other programs so often in chaos. I hate the idea of feeling as helpless regarding my healthcare as I do about politics in general.
And really, I have mixed feelings about some things regarding this subject. I don't want anyone to suffer Teko or go broke trying to stay healthy.
I mean . . . I've got a heart in there somewhere.
I just can't imagine this debacle of govt. being involved in something so precious as healthcare. I can't imagine how they would mess it up as you see other programs so often in chaos. I hate the idea of feeling as helpless regarding my healthcare as I do about politics in general.
I guess it must be (a matter of opinion that is). Isnt it so nice to agree on something? Oh the joy! Hope prevails! lol
Opinions are good to have. I never fault someone for having one even if it's different from mine.
I'm glad the ACA is working out fine for you. :>) There are a 'few' people that aren't very pleased. I guess it is . . . drum roll . . . a matter of opinion!
I'm glad the ACA is working out fine for you. :>) There are a 'few' people that aren't very pleased. I guess it is . . . drum roll . . . a matter of opinion!
Uh Oh, guess I should have added the imo (in my opinion eh?). You got yours and I got mine! And yes, the ACA is working out just fine~ and that is my opinion as well.
What does that have to do with motivation to work?
We are very different in our opinions of a single payer system. As there are a whole lot of people that feel the way I do and a whole lot of people who feel the way you do, there is no guarantee that is the way we are headed.
I mean, the ACA is working out so well and all . . .
Im all about single payor. It is the way we are heading and it only makes sense to me as we are so behind in the game. Gee I wonder how that would effect motivation to work!/s
This is what interested me:
"...Drasga and Einhorn state their case for a single-payer system by delineating problems that such a system could address:
Reduced administrative costs, which currently account for almost a third of healthcare expenditures
Eliminating many bankruptcies attributable to healthcare costs, which accounted for more than 60% of family bankruptcies identified in a 2009 report
Improved health, as indicated by evidence that being uninsured increases the mortality hazard by 40%
Building on an existing structure, noting that about 60% of all healthcare in the U.S. is publicly funded
Implementation of proven cost-containment strategies, which are absent from the ACA
Improving quality of care and outcomes by increasing access to care
Reverse the trend toward for-profit, investor-owned healthcare plans
Preserve physician's income potential, as judged by experience with the Canadian healthcare system
The authors devoted special attention to the cost of drugs and devices. They cited a study showing that pharmaceutical companies charge 50% more in the U.S. than in Europe for the same drugs. Much of the difference can be traced to large outlays for marketing and for a 20% profit margin, they said. By comparison, research and development (R&D) accounts for about 13% of drug costs.
The Department of Veterans Affairs gets a 40% discount on medication by buying in bulk. Medicare is legally forbidden to negotiate drug prices.
"Lower drug prices would not jeopardize drug innovation," Drasga and Einhorn stated. "Most true innovations in therapeutics (as opposed to me-too drugs that are slightly different versions of existing drugs) stem from publicly financed research." ..."
"...Drasga and Einhorn state their case for a single-payer system by delineating problems that such a system could address:
Reduced administrative costs, which currently account for almost a third of healthcare expenditures
Eliminating many bankruptcies attributable to healthcare costs, which accounted for more than 60% of family bankruptcies identified in a 2009 report
Improved health, as indicated by evidence that being uninsured increases the mortality hazard by 40%
Building on an existing structure, noting that about 60% of all healthcare in the U.S. is publicly funded
Implementation of proven cost-containment strategies, which are absent from the ACA
Improving quality of care and outcomes by increasing access to care
Reverse the trend toward for-profit, investor-owned healthcare plans
Preserve physician's income potential, as judged by experience with the Canadian healthcare system
The authors devoted special attention to the cost of drugs and devices. They cited a study showing that pharmaceutical companies charge 50% more in the U.S. than in Europe for the same drugs. Much of the difference can be traced to large outlays for marketing and for a 20% profit margin, they said. By comparison, research and development (R&D) accounts for about 13% of drug costs.
The Department of Veterans Affairs gets a 40% discount on medication by buying in bulk. Medicare is legally forbidden to negotiate drug prices.
"Lower drug prices would not jeopardize drug innovation," Drasga and Einhorn stated. "Most true innovations in therapeutics (as opposed to me-too drugs that are slightly different versions of existing drugs) stem from publicly financed research." ..."
The world of oncology is its own. There are many things involved. Yep, high cost of medicines with very low rates of cure. People often do not wish to give up when cancer progresses. It's so sad if you've ever been involved with a family going through this. Probably a very hard place for a doctor. You find many entering patients in clinical trials or using medications off label but still, the outcomes that are the average length of time after diagnosis usually do not change.
I know that my mother in law's oncologist was still giving her hope and allowing her to undergo more chemo when he'd verbalized to one of her sons that she'd be gone within a month (she died a week later).
Cancer is evil. And expensive to treat. Cancercare.org has patient assistance programs for families if anyone you know is suffering cancer.
I know that my mother in law's oncologist was still giving her hope and allowing her to undergo more chemo when he'd verbalized to one of her sons that she'd be gone within a month (she died a week later).
Cancer is evil. And expensive to treat. Cancercare.org has patient assistance programs for families if anyone you know is suffering cancer.
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