The American system of health care is deeply flawed - it is over regulated and tort law distorts medical practice - however it remains the gold standard in clinical outcomes. This is because Americans get access to the best treatments in the world, without rationing that occurs in the United Kingdom.
Yet there’s been a recent change in the healthcare dynamic in America that’s making it look more like the UK.
There are many horrifying aspects of the British health system - weeklong waits to see a family doctor, further waits to see a consultant, but by far, the biggest negative is the lack of access to the most cutting-edge drugs. Overall, 5,000 people a year die in the UK that wouldn’t if they were receiving US standards of healthcare.
Rather than seeing the UK emulate the best of the US system, it is disturbing to see the reverse, with the appearance of groups in the U.S. like the Institute for Clinical and Economic Review (ICER), clearly inspired by the misnamed National Institute for Health and Care Excellence (NICE). To restrain costs here in Britain, the government introduced NICE to assess and ration treatments available to the British public.
ICER, like NICE does in the UK, is bringing similar health rationing to the US. At least in Britain there is little hiding the links between the government-funded NICE and the government-funded National Health Service (NHS). But ICER portrays itself as being independent when it is nothing of the sort, as it was founded and is being run by people with strong ties to the insurance industry.
NICE bases its guidelines on quality-adjusted life years (QALY), which seldom endorses treatments costing more than £30,000 per additional year gained. Obviously this causes great pain and suffering to the patients and the families of patients when they are denied access to the best treatments available on grounds of cost.
QALY is a horrific, bureaucratic invention that values a sick person as less than a healthy person. Depressed? - You lose points. Can’t walk or need a walking stick? - Your life is worth less. Oh, and don’t get old under a QALY system. So it should be noted that ICER is using QALYs as it determines if new drugs are worth the money, and then makes recommendations to payers about whether they should be covered.
On assessing a new drug that gives a marginal improvement over an older and cheaper drug, any increased cost drives down points, and a patient is less likely to get the best care. Whether it be a new car seat for my infant son or cancer treatments for a loved one, a 10% improvement is significant - even if it costs more!
This has contributed to the abysmal cancer survival rates in Britain compared with the US. For lung cancer, an American is twice as likely to be alive in five years as a Briton. In all cancers investigated by the CONCORD-2 study, Americans with cancer outlive their British cousins.
Speaking with one of Britain’s top cancer specialists a few years ago, I inquired what he would do if he were diagnosed with cancer. “Fly to New York” was his answer.
It should be concerning for Americans that ICER is set to review new therapies for small cell lung cancer. It recently reviewed a drug for another type of cancer, Multiple Myeloma, and, not surprisingly, it found the drug too expensive.
Meanwhile, insurance companies and pharmacy benefit managers can use ICER’s findings to limit coverage or as leverage with manufacturers. According to Milena Izmirlieva, who leads the IHS Life Sciences research team, “ICER’s reports – no matter whether they lack methodological rigor or not – may be used as ammunition by health insurers in their attempt to secure price discounts.”
Being well aware of the poor standards of the government-run healthcare system, I along with my family have purchased private medical insurance in addition to paying high taxes for care we will never use. I know if I take the “free” government healthcare, this comes with rationing and second-rate treatments. By paying for private insurance, I can expect to receive the best treatments available in the world.
It must be a shock to Americans with private insurance to find that their insurance companies are listening to a group that imitates the British government’s approach to healthcare. The lack of transparency about ICER’s bias and that it is, in effect, acting as a NICE rationing body is appalling.
I’ve had the choice to opt out of the rationed British system, but I doubt many Americans are even aware of ICER, let alone its newfound control over their healthcare choices.