U.S.Women with breast cancer denied access to lifesaving treatment

[hawthorne]

I’m sorry if Smartass has departed this thread, because his responses beg some questions. I stopped posting along the “when might government be justified” line a while ago since it was a thread hijack, but since the OP has disappeared, I’ll hop back in.

First, Smartass seems to agree that private insurance companies would set rules on medical treatments funded. Note that this is because (1) decisions on treatment are made by doctors since patients lack information and (2) due to risk, patients insure, so that payments are predominantly made by third parties and the monitoring discipline of prices in the market are absent in health care. (see any health economics text)

If private companies can set limits as to allowable treatments, why might not government? Smartass seems to object mainly on the grounds that it is government, not on the nature of the limitations, and lauds objections to this.

Surely, even if government sets inappropriate guidelines, it does not make those who break them moral heroes. It just makes them fools in an inappropriate system. If a government corruptly allocates property rights, a person who steals is still a thief, he is not striking a blow for liberty. Likewise a person who regards FDA regulation as overweening should not regard someone who touts a quack treatment as striking a blow for liberty, merely as an inadequate in an inadequate system.

Thirdly, the fire protection analogy is entirely misconceived. The externalities (effects unpriced in the market) in fire protection are entirely local, and one cannot subscibe to another jurisdiction’s fire protection if one wishes to free-ride. The issue as to the appropriateness of government-provided fire services is, in addition, not an issue of whether there would be any fire services provided for in the market, but whether it would internalise all marginal externalities.

The effects of health regulation cross local boundaries due to patient mobilty. Setting local limits would be entirely ineffective, due to interjurisdictional competition. In any case there is no reason to supppose that local voting is any more “representative” of preferences than national voting. (Brennan/ Buchanan or any public choice text on the “paradox of voting”)

Finally, Smartass persists in defining the legitimate role of government to one which conforms to his ideology (one that I might add I have considerable sympathy with). This is not the point: the rules of society are (as opposed to ought to be) a compromise. Some pople are libertarians, some aren’t. The legitimate role of government within that compromise can be argued about. The issue of whether it is a good compromise is entirely different.

That Smartass would set different rules about the scope of government is relevant only if s/he can get others to agree. If not s/he has to take into account the views of others in order to gain their consent (which is presumably Smartass’ criterion of legitimacy).

picmr

[hawthorne]

Hmmm, just re-read my post and it sounds like an economist who’s posting at 1.30am after having a few drinks. Sorry if it sounds sniffy or is incomprehensible to non-economists.

picmr

[Smartass]

picmr:

Glad you rejoined us. I always enjoy your posts, but admit they require a lot of concentration. Since most of your discussion involves me, I wonder why you have held me in the third person.

If it helps, my father-in-law is an economist–he tends to use much easier words but to make a lot less sense.

On to your points:

If private companies can set limits as to allowable treatments, why might not government? Smartass seems to object mainly on the grounds that it is government, not on the nature of the limitations, and lauds objections to this.

No seeming about it–that is why I object to it. Rather than repeat what is in this and a lot of other threads, I’ll limit myself to the reason that the government is not subject to the market.

Surely, even if government sets inappropriate guidelines, it does not make those who break them moral heroes. It just makes them fools in an inappropriate system. If a government corruptly allocates property rights, a person who steals is still a thief, he is not striking a blow for liberty. Likewise a person who regards FDA regulation as overweening should not regard someone who touts a quack treatment as striking a blow for liberty, merely as an inadequate in an inadequate system.

I do not think Ms. Esterly is a moral hero–I think she may be a nut. Also, I don’t think she is striking a blow for liberty–if anything, she is striking a blow for empty rhetoric. However, I do think that by supporting her right to choose in this public debate and trying to convince others to agree, that I am striking a blow for liberty, albeit a small one.

Thirdly, the fire protection analogy is entirely misconceived…In any case there is no reason to supppose that local voting is any more “representative” of preferences than national voting.

There is nothing here I disagree with strongly enough to dispute. It would amount mainly to nit-picking.

Finally, Smartass persists in defining the legitimate role of government to one which conforms to his ideology (one that I might add I have considerable sympathy with). This is not the point: the rules of society are (as opposed to ought to be) a compromise. Some pople are libertarians, some aren’t. The legitimate role of government within that compromise can be argued about. The issue of whether it is a good compromise is entirely different.

I thought we were arguing about the legitimate role of government. Also, if there are compromises, I’m going to try to use my arguments to sway them. Also, I’m not sure I grasp your point.

That Smartass would set different rules about the scope of government is relevant only if s/he can get others to agree. If not s/he has to take into account the views of others in order to gain their consent (which is presumably Smartass’ criterion of legitimacy).

Smartass is a he–no need to fool with that silly frontslash. The entire purpose of my posts here is to try to “get others to agree”, hopefully by comparing my views to theirs. Are you reading another purpose here?

Hmmm, just re-read my post and it sounds like an economist who’s posting at 1.30am after having a few drinks. Sorry if it sounds sniffy or is incomprehensible to non-economists.

Be careful. I suspect every time you talk in your sleep, somewhere an accountant dies.

-VM

[hawthorne]

Be careful. I suspect every time you talk in your sleep, somewhere an accountant dies

My wife already thinks I love sleep too much. Now I have a reason!

The s/he forward slash was only silly because I didn’t know, and couldn’t be bothered trying to find out. Oops, but fair enough (though I do say so myself).

I respond to you Smartass because whilst I sometimes disagree with you, you read and you think. I’ll take that over someone who’s right for the wrong reasons.

Commiserations on your relo being an economist. My wife’s a lawyer. We take turns on being scum o’ the universe at parties.

picmr

[Smartass]

picmr:

I am now wondering whether you get grilled harder for sharing opinions at home or on this board.

-VM

[California_Girl]

One question… has she considered going to Europe for this treatment. I believe she claimed somewhere that women there are able to take advantage of it…?

[psychobunny]

Not quite sure why I feel the need to add my $.02 but here goes:

A while back Ms. Esterly stated that bone marrow transplant for breast cancer was approved with minimal study and then was proven to be ineffective. The truth is that this treatment was considered experimental and in the process of being tested. Unfortunately, there was a well-publicized case where a California woman sued to get this treatment covered by her insurance company citing similar reasons to those Ms. Esterly uses (she should have the right to any potentially helpful treatment etc.) The woman in California won more than $80 million, subsequently had her transplant but died anyway. Insurance companies felt the need to cover this treatment to avoid similar large settlements and many women received this “potentially lifesaving” treatment.

After the studies were completed, it was found that this treatment is in fact not helpful and carries up to a 50% risk of death from the treatment alone.
Now I, as a doctor, fully believe that Ms. Esterly has the right to spend her own money on any quack treatment she wants. However, I cannot support the FDA approving a treatment for federal funding, or insurance companies therefore being considered required to cover it without some hard scientific evidence that it works.

We may not have the right to protect patients from themselves but we do have the right to protect taxpayers and people who pay insurance premiums from having to pay more in order to cover unproven therapies.

[tracer]

David B wrote:

Harkenbane said:

we are deciding for ourselves that this doctor is a quack before he has given us any solid evidence

No, we are deciding that he might be a quack because he hasn’t given us any solid evidence.

Worse.

We are deciding that he might be a quack because, not only has he not given us any solid evidence, others have given us evidence against his treatment. The following quote from the American Cancer Society appears on page 1 of this thread:

During the 1980s, NCI studied cases of cancer patients that Dr. Burzynski had treated with antineoplastons. There was no evidence that these patients benefited in any way from the antineoplaston treatment. In 1985, the Canadian Bureau of Prescription Drugs examined records of patients of Canadian doctors treated at Dr. Burzynski’s clinic in Houston. It found that of 36 patients, 32 had not benefited from the treatment and had died. Of the remaining four, one died after some slight improvement, one died after stabilizing for a year, and two were still alive, but had widespread cancer.

[David_B]

Good point. Thanks for the addition to my statement.