Cancer and the Government

Cancer and the Government, by Michael D. Tanner
Cato, May 20, 2009

The American Cancer Society Cancer Action Network announced recently that it will spend $3 million over the next several months not on urging Americans to stop smoking or get mammograms, but on campaigning for a government takeover of the U.S. health-care system. This is perverse: It's hard to imagine anything worse for cancer patients than government-run health care.

For all its faults and all the criticism that it has received, the United States' free-market health-care system has made America the place you want to be if you have a serious illness.
Cancer patients understand this. The overall five-year survival rate for all types of cancer for men in America is 66.3 percent, and 62.9 percent for women, the best outcome in the world.

We shouldn't be surprised. The one common characteristic of all national health-care systems is that they ration care.

Sometimes they ration it explicitly, denying certain types of treatment altogether. More often, they ration more indirectly — imposing global budgets or other cost constraints that limit the availability of high-tech medical equipment or imposing long waits on patients seeking treatment.

In the United States, there are no such government-set limits, meaning that the most advanced treatment options are far more available. This translates directly into saved lives.

A prime example of denying patients treatment that has the potential to, if not save, at least prolong one's life comes from the much vaunted National Health System (NHS) in the United Kingdom. In order to keep the budget under control, the U.K. government established the National Institute for Health and Clinical Excellence (or NICE). NICE acts as a comparative-effectiveness tool for NHS, comparing various treatments and determining whether the benefits the patient receives, such as prolonged life, are cost-efficient for the government. Outlines for reform put forth by President Obama and Democrats in Congress include a comparative-effectiveness body similar to NICE.

NICE, however, is not simply a government agency that helps bureaucrats decide if one treatment is better than another. With the creation of NICE, the U.K. government has effectively put a dollar amount to how much a citizen's life is worth. To be exact, each year of added life is worth approximately $44,305 (£30,000). Of course, this is a general rule and, as NICE chairman Michael Rawlins points out, the agency has sometimes approved treatments costing as much as $70,887 (£48,000) per year of extended life.

Approval for expensive treatments, regrettably, is the exception and not the rule. Such treatments are only approved if it can be shown they extend life by at least three months and are used for illnesses that affect fewer than 7,000 new patients per year. After all, as Rawlins notes, "We have a finite pot of money."

This unfortunate truth has led to many controversial decisions in Britain. Most recently, in August 2008, NICE refused to approve four new treatments for kidney cancer, three of which had already been approved for use in the U.S. for a year or more. In April 2009 NICE reversed its ban on one drug, Sutent. Sutent can double the life expectancy of patients and costs around $35,465 (£24,000) per year. For the other three drugs, however, NICE confirmed its ban, despite each having similar costs to Sutent.

The advantages of free-market health care go far beyond an absence of rationing. With no price controls, free-market U.S. medicine provides the incentives that lead to innovative breakthroughs in new drugs and other medical technologies. U.S. companies have developed half of all the major new medicines introduced worldwide over the last 20 years.

In fact, Americans played a key role in 80 percent of the most important medical advances of the last 30 years. Eighteen of the last 25 winners of the Nobel Prize in Medicine either are U.S. citizens or work here.

If the American Cancer Society got the government-run national health-care system it wants, we would eliminate consumer choice and put a stop to the innovations we count on to improve our health. It would condemn thousands of cancer sufferers to waiting lists and denied care. In the end, it would cost lives.

If the Cancer Society truly wants to help Americans suffering from that complex array of diseases called cancer, it will get back to campaigning for mammograms and quitting smoking, and keep the government out of the picture.