Jewish World Review July 26, 2004 / 8 Menachem-Av, 5764
Bad Rx for bad system Mega Meds lot's obscene sense
Step right up, folks, and enter the Mega Meds Lottery. If you're one of the lucky winners, Medicare will help pay for your cancer drugs. If you don't win, well, better luck in the next life.
For pure creepiness, this recent invention of Congress has few equals. The full Medicare prescription-drug benefit doesn't start until 2006. When it does, elderly and disabled Americans will get subsidies to buy oral drugs for treating cancer, multiple sclerosis and other serious diseases. In the meantime, they can play the odds. (Medicare already covers drugs administered through the veins or in a medical facility.)
The competition is hot. More than 500,000 Medicare recipients without drug coverage need these medications and so are eligible, according to the U.S. Department of Health and Human Services.
The rivalry may be intense, but the winnings are impressive. For example, the patient with chronic myelogenous lymphoma can get a payoff of over $40,000 a year toward the cost of the drug Gleevec.
The lottery was written into last year's Medicare prescription-drug law as a "demonstration program" something to give the fortunate few a taste of drug benefits to come. Everyone needing these critical medicines can't be a "winner" because Congress limited the funding to $500 million. That's why the benefit will go to only "50,000 lucky individuals," in the words of HHS Secretary Tommy Thompson.
Bad taste doesn't start to describe a government program that turns help paying for life-saving drugs into a game of chance. But is distributing a drug benefit through a lottery "ethical"?
Rationing isn't the problem. In every country, the demand for medicine exceeds the resources allocated.
"We ration all over the place," says William Winslade, who teaches law and ethics at the University of Texas Institute for the Medical Humanities. "It's the way we do the rationing that is troubling."
Organs are a scarce commodity, but we don't run a lottery to ration livers and hearts. The organs are supposed to go to the sickest people on the waiting list. Some may not like that system, but Lady Luck plays no part in it.
All entrants in the Mega Meds Lottery have the same chance of winning, and that poses ethical problems, Winslade notes. The lottery does not distinguish between rich people, who could afford their own drugs, and poor people, who might have to go without if they lose. (It does give more help to low-income winners, however.) The lottery also does not rank players according to how ill they are.
And, of course, it does nothing for equally sick younger people who are not in Medicare. Congress has always lavished the most generous health-care benefits on the elderly, a politically powerful group. It wouldn't think of helping the uninsured 34-year-old with breast cancer pay for her Tamoxifen. But why can't she at least enter the lottery?
We interrupt this column to note how gruesome the whole discussion is. That the richest nation on earth can't find the money to get critical medications to all sick citizens is outrageous. Canadians get the meds they need. Japanese get what they need. What Americans get is a lottery.
The lottery is a grotesque extension of an insane health-care system, which few in power seem willing to change. Everyone is so beaten down by the lack of a coherent policy that any new government benefit, however weird, draws thanks. The American Cancer Society clearly wasn't thrilled with the idea of a casino-based distribution system for cancer drugs. But it meekly noted that the lottery was better than nothing.
Finally, there's the matter of the prices the lottery winnings will be subsidizing. Captive to the drug industry, Washington politicians have designed a Medicare drug benefit that does too little to control what the drug makers charge. How many more winners could the Mega Meds Lottery produce if the $500 million were buying drugs at Canadian prices?
The Centers for Medicare and Medicaid Services is now taking names. Good luck to all of you. The odds about nine to one are not terrific, but don't let that deter you. The application is only 18 pages long. And remember this: You can't win it if you're not in it.
Froma Harrop is a columnist for The Providence Journal. Comment by clicking here.
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© 2004, The Providence Journal Co.
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