Sad story out of Oregon, but a familiar story to anyone who has followed health care issues during any part of the past 40 years: A woman gets cancer, her physician recommends a pharmaceutical or surgical procedure, but the insurance company denies coverage.
In this case, the story is being pushed by opponents to health care reform as a scare tactic. ‘Health care reform means cancer-fighting drugs won’t be covered.’ The tenuous link to reality this argument has is this: The woman is insured by Oregon’s public insurance alternative, a one-state effort to do what private insurance failed to do. So, the critics reason, if she can’t get coverage under Oregon’s public plan, no one will get coverage under any government plan.
The pharmaceutical is a recently-developed cancer fighter, Tarceva.
It’s a crude bluff. Reality is different.
- Medicare may pay for coverage of the drug in question, Tarceva. The Oregon public program has a rather high standard for coverage — 5% chance of survival for 5 months or more, established in clinical trials — but Medicare supplemental insurance plans, a federal program, will pay for Tarceva for non-small cell lung cancer treatments. Oregon’s program may not be equivalent to the federal program proposed.
- Private insurance companies often deny coverage for cancer treatments. The story from Oregon shows the disparities in care, and it demonstrates well that rationing of health care is a key feature of the current system, a key reason to work for reform. But denial of coverage occurs across the nation, and, I think statistics would show, more often from private insurance companies, often for less judicious reasons. In Kansas, Mary Casey got the rejection from her private insurance company: “But when Casey went to fill her Tarceva prescription at the pharmacy, her insurer, Coventry Health Care of Kansas, denied her coverage for the drug, saying it considered Tarceva experimental in her case, even though Tarceva is FDA approved for other lung and pancreatic cancers.” There is no significant difference between private coverage and the Oregon public plan.
- Private insurance failed: This woman is on the Oregon plan because private insurance didn’t provide any coverage for her.
Barabara Wagner’s story troubles anyone with a heart. It’s not an argument against reforming health care and health care insurance, however, because Wagner wouldn’t be alive to this point without a government plan in Oregon, analogous to the public option proposed in the House bill; because private insurance does not differ significantly in its coverage of cancer victims; and because this woman is on a public program in the first place because private insurance simply failed to cover her at all. Under private insurance, this woman would have been dead months ago, if not longer.
- Genentech is the inventor of the this drug. Genentech offers assistance to people who cannot otherwise afford it. (Therapy with Tarceva generally runs in the thousands of dollars per month.) (One more pharmaceutical brought to you couresy of applied evolution theory. Do creationists refuse the therapy because it’s Darwinian?)