24 replies to this topic

[Palisades]

Quote

Medicare to pay for $93,000 prostate cancer drug
By MATTHEW PERRONE, AP Health Writer

WASHINGTON – Medicare officials said Wednesday that the program will pay the $93,000 cost of prostate cancer drug Provenge, an innovative therapy that typically gives men suffering from an incurable stage of the disease an extra four months to live.

The Centers for Medicare and Medicaid said the biotech drug made by Dendreon Corp. is a "reasonable and necessary" medicine. The decision ensures that millions of men would be able to afford the drug through the government-backed health care coverage. With government reimbursement, analysts estimate Provenge could rack up $1 billion in sales next year. The decision, which will be finalized by June 30, is important for Dendreon because most prostate cancer patients are 65 or older.

Medicare is legally prohibited from considering price when deciding whether to pay for a new treatment. ...

The infused drug is a first-of-a-kind treatment in that each dose is customized to work with a patient's immune system. Seattle-based Dendreon says Provenge's price reflects the more than $1 billion spent researching and developing the drug. And prostate cancer patients point out that the median survival time with Provenge is double that of chemotherapy, which is about two months and is marked by significant side effects.

"It's impossible to put a dollar figure on a human life, especially when you're talking about a drug that has such mild side effects," said Jim Kiefert, a prostate cancer patient and advocate who was part of the Provenge study. "Of all the treatments I've had — with surgery, radiation and hormone treatment — Provenge had fewer side effects than any of them."

But bioethicists who study health care decisions say Medicare's ruling on Provenge mirrors the bias of the overall U.S. health system, which emphasizes expensive treatments over basic medical care. Health care costs account for nearly one fifth of the U.S. economy, more than any other country.

"We tend to put our health care dollars into very high-tech interventions that produce very marginal improvements," said Dr. Steven Miles, a professor at the University of Minnesota's Center for Bioethics. "The problem is that we have created a health care system that is uniquely inadequate in terms of access to primary health care, which is where you get the most bang for your buck."

A growing number of biologically engineered cancer drugs are being priced in the $100,000 range, including therapies from Roche and Eli Lilly & Co. Last week, Bristol-Myers Squibb Co. received approval for a new melanoma drug that will be priced at roughly $120,000 per patient.

I don't agree with this decision at all. We need to spend our health care dollars more wisely. The $93,000 price tag is ridiculous -- as is spending on-fifth of our economic output on health care when most of those dollars go to high-cost drugs and procedures that deliver marginal results.

Edited by Palisade, 31 March 2011 - 12:23 AM.

[offworlder]

so are you saying change the legislation about the 'legally prohibited from considering price' ?
and then have the legislation not allow for any drugs that have the high R&D behind them? which really includes
everything for cancer because cancer research is long term, with high salaried research experts and institutes ?

[Palisades]

^ More like I'd change the legislation such that it wouldn't pay for low-value drugs and treatments. For example, a $93,000 drug that actually cured the cancer instead of buying another two months of life (compared to normal chemotherapy) might pass the test if it was the only option. Also, I know prostate cancer can be cured if it's detected early by routine screening and surgically removed before it metastasizes.

Also, high R&D-cost drugs with only a moderate benefit could still pass the test if they were used by a broader segment of the population than men with prostate cancer that has progressed to the advanced stage. If you can spread the R&D cost across more drug recipients, the cost of the drug goes down.

Edited by Palisade, 31 March 2011 - 11:30 AM.

[Tricia]

I have to say that when I read the article the fact that the drug was $93,000 per patient so it took a while for the rest to register...okay, it was also early in the morning and I wasn't completely awake...

I know that it's hard to place a price tag on a few more weeks on someone's life but $93,000!!!!

I'm quite frankly shocked at that price tag and for that kind of price I'd expect a total cure or something more than just a few extra weeks of life when no doubt, one is already not in any kind of shape to enjoy it.

Now the $120,000 drug for melanoma?  Or the other $100,000 plus price-tagged drugs?  It depends on what they do, what kind of real effect they would have on the person's health.  For that price, the effect has to be more substantial and lasting than 'a few extra weeks'

I don't want to sound heartless but those price tags are enough to give anyone pause.

[Mark]

Mark: It only gives the patients four more months of life? No way would I agree with the decision to have Medicare pay for it, or prolong a loved-ones agony who has this terminal stage of prostate cancer.
What I would agree with, and do condone, is putting some of that money into early detection, and treatment of prostate cancer. I've already heard reports that a blood test can point out men most likely to develop prostate cancer. Put Medicare money towards patient's being able to get tested, and get preventative treatments, rather than pouring money into someone who is already terminal.

I found out a few days ago, that Medicaid only covers around $30 for eyeglasses for people receiving benefits. I'm quite certain they had to pay out far more than that for the Optometrists visit I went to, to obtain the prescription for those glasses. What if the Dr. prescribed glasses for me that cost much more than $30? For that matter, I've never seen a pair of glasses with corrective lenses for that little bit of money. Strange how Medicaid will completely pay for my doctors appointments, emergency room visits, and all the medication prescribed for me (unless, of course,  it's something that doesn't affect my mental, or physical well being), and won't pay more than $30 for eyeglasses! Heck, I've seen optical coatings for glasses go for that much all by themselves!

Edited by Mark, 31 March 2011 - 12:41 PM.

[Cait]

After all the nonsense generated over Health Care reform and "Death Panels", NOW you're [generic you] drawing the very line you balked at before.  You're effectively saying 'Where to draw the line of death.  Congratulations.  Death Panels are only a vote away.  Yet another measure that will allow the rick to live and the poor to die, because just how much can 4 months mean to a poor man who can't afford the damn treatment.

Honestly, I can't believe this kind of thinking.  How about controlling the freaking cost.  No, just let the sucker die.  *shakes head*  Or stop covering a treatment.  Are you kidding?

Edited by Certifiably Cait, 31 March 2011 - 01:51 PM.

[Palisades]

^ I've never been one of the ones complaining about the so-called "death panels." If we're honest with ourselves, we only have so many dollars that we can afford to spend on health care so we should get the most bang-for-the-buck that we can out of those dollars. That includes trying to lower costs. It also includes not paying $93,000 to get an expected extra four months from a battle against terminal cancer. Regular prostate screening will detect prostate cancer while it can still be surgically removed, thus eliminating the cancer entirely rather than buying an extra four months. If someone doesn't care enough about himself to to take the high-value route and go in for the screenings (which Medicare covers starting at the recommended age of 50), why should taxpayers be expected to pony up the $93,000 after the cancer is already terminal?

Edited by Palisade, 31 March 2011 - 03:02 PM.

[Cait]

Palisade, on 31 March 2011 - 02:09 PM, said:

^ I've never been one of the ones complaining about the so-called "death panels." If we're honest with ourselves, we only have so many dollars that we can afford to spend on health care so we should get the most bang-for-the-buck that we can out of those dollars. That includes trying to lower costs. It also includes not paying $93,000 to get an expected extra four months from a battle against terminal cancer. Regular prostate screening will detect prostate cancer while it can still be surgically removed, thus eliminating the cancer entirely rather than buying an extra four months. If someone doesn't care enough about himself to to take the high-value route and go in for the screenings (which Medicare covers starting at the recommended age of 50), why should taxpayers be expected to pony up the $93,000 after the cancer is already terminal?

I actually agree that regular check-ups and preventive care = lower medical costs.  And believe me, I too am torn between what will amount to death panels [it's what we already have actually only the government doesn't make the decision, Insurance companies do] and the use of taxpayer money.  I'm just not ready to throw dying people under the buss because medical costs are so high and BIG PHARMA wants to charge 93,000 for a pill.  Does no one see how outrageous that is?  

Sure, I understand research costs, but the cost of research on a treatment like the one we're talking about is off-set by treatments that have long ago paid for themselves and keep on delivering.  Just how much profit is OK when balanced against the lives of Americans?  It's one thing to discuss this in pragmatic terms, it's another to live with a doctor or insurance company or the government telling you to go die.  Especially when we're telling the poorest to go die because they could not afford insurance and have regular check-ups and preventive care.  It's a vicious circle, but no matter what, it's the poor and lower working class that will bear the brunt of this.  

Why so much hate towards the poor.  It's overwhelming lately [not from members of this board, but in the country and government]

[and apologies to eveyrone about the death panels crack.. I was livid for a moment. ]

Edited by Certifiably Cait, 31 March 2011 - 03:40 PM.

[Tricia]

I'm just flabbergasted at the price tag here.

Not sure why so high with the drug listed in the OP beyond it's newness but then again I am astonished at the price of prescription meds already.

I have health insurance through my employer so I have only a small co-pay for prescriptions but when I read the receipt/paperwork on the bag and see how much I saved by using my insurance, it often gives me a shock.  What if I did not have health insurance?

Medicare in general does not pay for prescription drugs anyway or at least not without the purchase of extra coverage.  With this being a drug for cancer which is one of the exceptions, I think that cost is inflated to take advantage of Medicare since even Standard coerage pays for that. Cost inflation or at least that is what it looks like(bolding and underlining below mine)

Quote

If you want prescription drug coverage through Medicare, you have to join a Medicare Prescription Drug Plan, or a Medicare Advantage or other Health Plan that offers this coverage, such as a Medicare HMO. These plans cost extra. Standard Medicare coverage (Part B) does not cover prescription drugs except in a few cases, like certain cancer drugs.

Enrollment in a Medicare Part D Prescription Drug Plan is voluntary. Medicare prescription drug coverage is sold by private insurance companies and costs extra. Different companies offer different plans. Monthly premiums and covered drugs vary from one plan to another. Prescription Drug Plans have monthly premiums, annual deductibles, coinsurance/copayments, and a coverage gap. People with low or moderate income can get Extra Help from Social Security or from Prescription Advantage to help pay these costs.

Edited by Tricia, 31 March 2011 - 04:06 PM.

[Palisades]

Certifiably Cait, on 31 March 2011 - 03:37 PM, said:

I actually agree that regular check-ups and preventive care = lower medical costs. And believe me, I too am torn between what will amount to death panels [it's what we already have actually only the government doesn't make the decision, Insurance companies do] and the use of taxpayer money. I'm just not ready to throw dying people under the buss because medical costs are so high and BIG PHARMA wants to charge 93,000 for a pill. Does no one see how outrageous that is?

Sure, I understand research costs, but the cost of research on a treatment like the one we're talking about is off-set by treatments that have long ago paid for themselves and keep on delivering. Just how much profit is OK when balanced against the lives of Americans? It's one thing to discuss this in pragmatic terms, it's another to live with a doctor or insurance company or the government telling you to go die. Especially when we're telling the poorest to go die because they could not afford insurance and have regular check-ups and preventive care. It's a vicious circle, but no matter what, it's the poor and lower working class that will bear the brunt of this.

Why so much hate towards the poor. It's overwhelming lately [not from members of this board, but in the country and government]

First, the terminal prostate cancer patient wouldn't be thrown under the bus. He'd still receive pain meds paid for by Medicare. He'd just die a couple months sooner than if he received this expensive drug. Second, $93,000 might actually be a fair price for the drug if instead of value delivered one considers its R&D costs, testing costs, and risk of failure before being brought to market -- not to mention that the drug has to be specially customized for each patient. Third, if the price is outrageous, then the government shouldn't pay. In that case, the drug company might (gasp) lower the price.

Also, it's actually the middle class and perhaps the not-quite-rich that would bear the brunt (temporarily) if Medicare wouldn't pay for every single treatment and drug regardless of cost. AFAIK, the middle class uses Medicare much more extensively than lower-income individuals because you have to be able to afford the copays. Also, charging all sorts of extravagant medical treatment to our national credit card will eventually destroy our country's finances and collapse the ability of deficit spending to fund Medicare, making the people you're trying to help much worse off than if my value-based suggestions had been followed.

If medical costs can be slashed, that increases the amount of medical care that can be purchased, but otherwise we'll have to exercise voluntary restraint or have the bond market force that restraint on us. During the recession, we were allowed to get away with the immense deficit spending because of investors' flight-to-quality and because the Federal Reserve monetized large portions of the additional deficit through QE. This won't continue, and as a result of the QE, we're already seeing rising gasoline prices and the soaring food commodity prices that contributed greatly to the current unrest in the Middle East where buying food takes up half of a typical person's budget. Yes, we've had some bad harvests, and there is the peak oil situation, but the parabolic price runups and market action are indicative of speculation fed by excess liquidity. I hope all the resulting unrest, deaths, and war was worth it for the supposed braniacs managing our monetary and fiscal policy.

Edited by Palisade, 31 March 2011 - 05:00 PM.

[Palisades]

Tricia, on 31 March 2011 - 04:01 PM, said:

Medicare in general does not pay for prescription drugs anyway or at least not without the purchase of extra coverage.

What about Medicare Part D?

(Thanks, Bush (NOT))

[Tricia]

Palisade, on 31 March 2011 - 04:30 PM, said:

Tricia, on 31 March 2011 - 04:01 PM, said:

Medicare in general does not pay for prescription drugs anyway or at least not without the purchase of extra coverage.

What about Medicare Part D?

(Thanks, Bush (NOT))

That's the last part of the sentence "at least not without the purchase of extra coverage"

My mother is on Medicare and what she can afford to pay for extra coverage does not get her much...and the fact is that she does not get much to begin with as far as Social Security.  No retirement for my mom (that't what happens when you take time off to raise kids and then divorce the abusive husband who does have a pension) as she is still working and barely making it.  And too proud to let me help her much financially so I have to be sneaky about it. I'm still working on getting her Extra Help.

But even Standard Medicare coverage (part B) pays for certain cancer drugs...and it sounds like this $93,000 drug is one of those.

[Broph]

Tricia, on 31 March 2011 - 04:01 PM, said:

Not sure why so high with the drug listed in the OP beyond it's newness but then again I am astonished at the price of prescription meds already.

It costs a lot of money to bring a drug to market. And for every one that they bring out, there are dozens or even hundreds that aren't brought out/go nowhere. The money they get for this drug pays for its development, as well as paying for development for the ones that failed and development of the next one that will succeed.

They know how much money they need to get per year for the life of the drug (before generics come out) and divide by the number of people they expect to buy the drug. The market for aspirin is 300 million people in the US alone; the market for this drug is much smaller.

[Themis]

I have no money for premiums but I'm on one of the Medicare Advantage plans that has prescription coverage - there were 4 or 5 in my area.  It was an easy choice for me because all of my doctors are at Vanderbilt (so are on pretty much all plans) and my primary care doctor was one of the primary care doctors on the plan. Fortunately all of my prescriptions so far are generic and cost me either $5 or $12.50, but it still comes to $87 a month.  I'm still unemployed so my only income is early social security - and that's too much for me to get extra help with prescriptions!

[Cait]

Palisade, on 31 March 2011 - 04:27 PM, said:

First, the terminal prostate cancer patient wouldn't be thrown under the bus. He'd still receive pain meds paid for by Medicare. He'd just die a couple months sooner than if he received this expensive drug. Second, $93,000 might actually be a fair price for the drug if instead of value delivered one considers its R&D costs, testing costs, and risk of failure before being brought to market -- not to mention that the drug has to be specially customized for each patient. Third, if the price is outrageous, then the government shouldn't pay. In that case, the drug company might (gasp) lower the price.

I agree with you point on letting the market work [supply and demand] but that's not what happens.  IMO, there is price fixing, and simply saying don't buy the drug is not a solution in real time and real life.  Is it a long term strategy?  Maybe.  I don't believe that it is a free market[place.  If it were we wouldn't have the prices of drugs continually increasing like they have.  The escalating prices of food, gas, etc--sure, I can see the market at work, but not in PHARMA and Health Care.

There are lots of things in life that are for-profit, and more power to them for making as much as they can, but health care becomes a problem when profit is put over people's lives.  "First do no harm"?  Do you see any ethical problems here?  Or is our god really the marketplace and profits?.  It's that important?  So important that it's OK to deny treatment? I'm not suggesting that a company can't make back it's R&D, marketing, trials, FDA approval, etc.  What I am saying is they can't make it back on the lives of the ill and those in need of treatment.  And, I don't believe that is an all or nothing idea.

I'm not saying your are wrong in your assessment.  You're right in fact.  Taxpayers can't afford to foot the bill on a treatment at this price.  That cost shouldn't be absorbed by the same taxpayers in the private sector either.  We agree on that.

But, the [un]intended consequences of traveling further along the road of limiting access to life goes against everything I think humanity should be about.  We send humanitarian aid to every country in the world if they need it, and yet it's OK to proceed with non-humanitarian policies for our own people, because of profit?  Sure, sure everyone dies, and prostate cancer can be treated successfully in conventional ways [I have friends who have survived and continue to be in good health decades later].  But to set this as a kind of policy will lead to places I think will be our ruin as a country and a culture.  We won't have top wait for financial collapse.  We'll be morally bankrupt as a culture.

Quote

Also, it's actually the middle class and perhaps the not-quite-rich that would bear the brunt (temporarily) if Medicare wouldn't pay for every single treatment and drug regardless of cost. AFAIK, the middle class uses Medicare much more extensively than lower-income individuals because you have to be able to afford the copays. Also, charging all sorts of extravagant medical treatment to our national credit card will eventually destroy our country's finances and collapse the ability of deficit spending to fund Medicare, making the people you're trying to help much worse off than if my value-based suggestions had been followed.

Point taken re: the middle class.

As for working class, tell people that they must die so that BIG PHARMA can keep on making a profit.  See how many are willing to die to keep the greediest element of capitalism raking in the $.  And even though your characterization of the economy and finances is [as usual] accurate, I see a bad ending if we go this way too.  There may be no good ending to any of this.  We may in fact end up with actual death panels, but it doesn't matter because people already die because they are denied care.  Since we've already been doing it, this is just one more nail in the coffin of the uninsured, and a way to continue a policy put in place a long time ago by the Industry  -- Pay [exorbitant] costs or die.  What do they care.  People with the means to beg borrow and steal the money will do it to stay alive  [profits].  Those that can't--who cares. [they're dead]  Throw in some tort reform and you have a perfect storm of "who cares" for regular people.  Just bed over and take it sucker.

Quote

If medical costs can be slashed, that increases the amount of medical care that can be purchased, but otherwise we'll have to exercise voluntary restraint or have the bond market force that restraint on us. During the recession, we were allowed to get away with the immense deficit spending because of investors' flight-to-quality and because the Federal Reserve monetized large portions of the additional deficit through QE. This won't continue, and as a result of the QE, we're already seeing rising gasoline prices and the soaring food commodity prices that contributed greatly to the current unrest in the Middle East where buying food takes up half of a typical person's budget. Yes, we've had some bad harvests, and there is the peak oil situation, but the parabolic price runups and market action are indicative of speculation fed by excess liquidity. I hope all the resulting unrest, deaths, and war was worth it for the supposed braniacs managing our monetary and fiscal policy.

I totally agree with this last paragraph.  And, trust me I see the dilemma between morality and pragmatism.  There is only so much we can do.  We all do have to exercise restraint and help the recovery, but as a policy in heath care, I think this entire notion is an abomination.

[Palisades]

Certifiably Cait, on 31 March 2011 - 05:48 PM, said:

I totally agree with this last paragraph.  And, trust me I see the dilemma between morality and pragmatism.  There is only so much we can do.  We all do have to exercise restraint and help the recovery, but as a policy in heath care, I think this entire notion is an abomination.

Personally, I think a pragmatic approach that seeks to do the most good with the money we have to spend is morally superior to implementing a non-pragmatic approach that pretends we don't have limits. By all means, negotiate with the drug companies to try to get prices down. Try to eliminate inefficiencies in the medical system. However, we must operate within the real-world constraints of the situation. Also, the more money that gets sucked into healthcare, the less there is to pay for education, scientific research, and everything else.

Oh, and death is part of being human, as are the frailties of old age. Trying to pay any cost to escape them is simply denialistic and destructive.

[Nikcara]

Broph, on 31 March 2011 - 05:22 PM, said:

Tricia, on 31 March 2011 - 04:01 PM, said:

Not sure why so high with the drug listed in the OP beyond it's newness but then again I am astonished at the price of prescription meds already.

It costs a lot of money to bring a drug to market. And for every one that they bring out, there are dozens or even hundreds that aren't brought out/go nowhere. The money they get for this drug pays for its development, as well as paying for development for the ones that failed and development of the next one that will succeed.

They know how much money they need to get per year for the life of the drug (before generics come out) and divide by the number of people they expect to buy the drug. The market for aspirin is 300 million people in the US alone; the market for this drug is much smaller.

With this particular drug, there are a lot more costs associated with it than your normal drug anyway.

It has to be tailored to each person receiving it.  What that means is that it can't be mass produced.  Sure, many/most of the ingredients can be, but for each dose of the drug you have to have a person, sufficiently trained and knowledgeable, develop this drug for one patient.  And that person isn't going to be some blue-collar, minimum wage earner.  So there are the costs of meeting the patient to get a issue/blood sample, analysis of that sample, and THEN small-scale production.  I'm not actually surprised that the cost is $93,000 for a treatment.

Even when it goes generic it's unlikely the price is going to go down much.  When a drug goes generic, all that's released is the chemical compound.  Not how to make it.  So you would need to find someone able to figure out a way to produce it (depending on complexity, this can be fairly easy or next to impossible), plus a company that's willing to invest not only in a way to make it but also dedicated employees to collecting, analyzing, and synthesizing.

[Cait]

Palisade, on 31 March 2011 - 06:44 PM, said:

Certifiably Cait, on 31 March 2011 - 05:48 PM, said:

I totally agree with this last paragraph.  And, trust me I see the dilemma between morality and pragmatism.  There is only so much we can do.  We all do have to exercise restraint and help the recovery, but as a policy in heath care, I think this entire notion is an abomination.

Personally, I think a pragmatic approach that seeks to do the most good with the money we have to spend is morally superior to implementing a non-pragmatic approach that pretends we don't have limits. By all means, negotiate with the drug companies to try to get prices down. Try to eliminate inefficiencies in the medical system. However, we must operate within the real-world constraints of the situation. Also, the more money that gets sucked into healthcare, the less there is to pay for education, scientific research, and everything else.

Oh, and death is part of being human, as are the frailties of old age. Trying to pay any cost to escape them is simply denialistic and destructive.

I don't disagree with any of this, but I do disagree with it as law and policy.  What is pragmatic now, once policy will continue long after we don't need it.  History will reflect that.  Additionally I fail to see how recognizing the reality of a situation means there are no alternatives.  As I've stated a few times, I don't disagree with your assessment of the situation.  I disagree with making policy that institutionalizes what will become a death sentence for the working poor and the elderly.  Yes, we all die, and there is no avoiding that, but that doesn't mean that should accept an earlier death.  The idea offends my sense of humanity.  I recognize the reality, I disagree with the solutions presented to solve the problems these realities reflect.  We're in affect saying that BIG PHARMA gets to determine when we die by pricing our treatment out of range.  I disagree with profits over actual health care.

This actually perfects reflects a test question in an Ethics class I had in college.

There is a pill that will save your spouses life.  You cannot afford the pill, and there is NO other treatment available and your spouse will die.  What do you do?  

I remember we had to answer verbally, and as the prof went around the room to listen to answers I was at first afraid to speak, because my solution had not been voiced, and I was certain it was the right choice.  I was surprised to receive an A+.  There were lots of answers BTW, and all of them quite pragmatic.  I failed to see the ethics or pragmatism of letting someone die when a cure existed.  

Just sayin.

[Palisades]

^ Being born is a death sentence. Any taxpayer-provided medical care is at best a temporary reprieve. That said, what I propose, if done right, will result in the most good being done with the amount we have to spend. And, no, we can't steal the money (if that was your solution to your professor's exercise). While we could default on our debt, we'd only be able to do that once, and that might throw the entire world economy into chaos. The only way defaulting (restructuring debt) helps is if you at the same time get your house in order, spend your time in the penalty box of destroyed credit, and do things responsibly once you come out the other side. This is true for nations as well as individuals.

[Cait]

Palisade, on 31 March 2011 - 07:48 PM, said:

^ Being born is a death sentence. Any taxpayer-provided medical care is at best a temporary reprieve.

While pragmatically true, I doubt if you asked anyone that  they'd offer up their lives early to balance the budget.  Just sayin!

Quote

And, no, we can't steal the money (if that was your solution to your professor's exercise).

Actually, my solution wasn't what got me the A+, it was that I knew why I chose that solution.  It was an ethics class.  The Prof was looking to each student [which was why it was oral] for the "why" of each solution.  Did we know why we chose that?  What was the ethical underpinning of the solution?  Was it a culturally based decision, political, religiously influence,d etc.  And, we were willing to accept the consequences of our action.  Like I said, it was an ethics class.

My solutions wasn't to steal the money, it was to steal the treatment, save the life of my spouse, and then report myself to the authorities.  The reason I chose this solution was that a life [to me] was more valuable than property.  Property can be replaced.  A life can't.  I was willing to accept the consequences because of that belief.

And, since I've told you that, it is also the basis for my opinion on this particular topic.  Like I have said, I know you are stating some pretty grim but true facts about this, but I'm offended by the lack of reverence for life itself.  Life is perilous without any help from Insurance companies denying treatment.  Taken to an extreme, why should be care about soldiers dying in war, after all they were born already dying.  Why should we care about humanitarian work around the world?  They already dying.  Why should we care about any life at all?  We're all dying.

I agree that we only have so much $$ and we have to balance what we have against the priorities of a nation.  I also agree that people need to be responsible for their health and their own lives.  We're probably entering a period of time when those that can take care of themselves will fare better than those that can't or won't.  But, I'm still against making it policy to withhold treatment. based on treatments being too expensive, and that the expense is justified so that companies can make back their investments.  That's putting profits above human lives.  $$ can be made in many ways, but once someone is dead--there is no coming back.    Will it happen the way you state, probably, but I'm never going to say it is ethically OK.  I just can't say that.