Politicians: dodging reality, one dollar at a time

Here is another example of how much of what is batted about by government is just smoke and mirrors, primarily because reality is hard to sell.

Here is another example of how much of what is batted about by government is just smoke and mirrors, primarily because reality is hard to sell. I have said it before, but in case you missed it (I forgive you), Obamacare/Americare or whatever rework of it we are wasting time on, is never going to fix our healthcare system, because it is insurance-based legislation. Say it with me people: insurance is a way to pay the bills, but it doesn't do anything about how big the bills are. Why is government messing about then? Because they can make it look like it will help. Which gets you all excited and agitated. And then when whatever they did fails, they blame the other side. And that gets you excited and agitated too. And an excited, agitated voter is easy to manipulate and motivate. Especially with memes. Perfect! The only way to make healthcare less expensive is to... yep, you got it...spend less money on healthcare.

That doesn't sound quite as magical does it. Sometimes, reality bites.

But wait! Obamacare insured millions of people that were previously uninsured! Yup. And did nothing for the size of the bills, it just shifted who was paying, some of the money coming from people who were previously uninsured, some coming from the government (which, by the way, doesn't have enough money to pay its current bills, but let's not go there today).

People keep pointing to other countries and how they have great results but spend less money. How do they do it? By being smarter with their money. And we can do that too, but we are not going to like it.

I walked into my office this morning to this 33 page document on the highlights of prescribing Ketruda, a relatively new immunotherapy used on several different cancers, but lung cancer has been in the spotlight. You may have seen ads on TV like this one, which is for a similar drug called Opdivo.

These are a big deal right now, and in some cases these drugs are improving results significantly. That's all good, right? Yes, but there are some catches.

First, you need to understand that chemotherapy for lung cancer really sucks, because it has bad side effects and doesn't work very well. So doing better than the current standard is not too difficult. Second, the results of these new therapies are extremely variable and hard to predict: some patients will do well, some won't, some will have side effects, some won't. And often when we talk about "significant" improvements, people don't understand what that really means: we are talking about progression free survival differences of a few months. Now, I am not suggesting that is not significant, but some people associate "significant" with cure. And we unfortunately far from that.

What does this have to do with the price of tea in China?

I don't know about the price of tea, but we are talking about the price of healthcare, and how to bring it down, and how politicians don't really want to do anything about it, because working on real-world issues effectively is not so good for elections. These drugs are really expensive, like $150,000 a year. There is a reason that drug companies are marketing them direct to consumer. There is a reason that the stock prices of Merck and Bristol Myer Squib are fluctuating based on clinical trial results.

And there is a reason that countries like Canada and Switzerland are not using these drugs.

Because they do things like cost-benefit-analysis and decide if it is worth it to spend the money. And I don't think we the people are open to that yet. Yes, we like to point at other country's system's and how effective they are and how happy and healthy everyone is, but if a politician in our current, screwed-up I-don't-really-do-anything-but-campaign system were to introduce legislation that functioned in this way, their opponents would have a field day. They would accuse them of doing things like organizing death panels, just to save a few bucks at the end of life.

So instead, our fearless leaders work on stuff that you will like, ignoring the realities of life, putting out feel-good legislation that lets them look busy and gives them reason for you to get excited about them and get agitated by anyone who opposes their progressive, life-changing ideals. And an excited, agitated voter is easy to manipulate and motivate. Especially with memes. Always with the memes.