Two articles in the New York Times on Saturday demonstrate the difficulty we have constraining health care costs. We have trouble agreeing to cuts in home health care when independent analysis shows overly generous margins (on average), and we have trouble rejecting payment for a cancer drug that costs $36,000 a month, and has not been shown to have clinical benefit.
A front page article follows a home health nurse making rounds in rural Caribou, Maine Maine
MedPAC recommended sharp cuts in home health care, as its analysis showed that on the average the margin in home care was too high. (Of course, averages obscure many situations – and rural home care nurses who are only able to see five patients a day due to travel distances are very different than urban home care nurses who can walk from client to client!) This information from the Dartmouth Atlas shows that overall Maine has far less home health expenses than expected, even though more highly populated southern Maine
National Average: 434.5 services/1000
The front page of the business section of the paper highlighted Folotyn, a drug newly approved for peripheral T cell lymphoma. This disease is aggressive, strikes under 6000 in the US
...Dr. Lee N. Newcomer, senior vice president for oncology at the big insurer UnitedHealthcare, called the price of Folotyn “unconscionable.” He said that Folotyn alone would cost as much as UnitedHealthcare now typically spends in total to treat a lymphoma patient from diagnosis until death. That median expenditure now, he said, is $87,000 for a little over a year of treatments.
But Dr. Newcomer said insurers would be obligated to pay for Folotyn because there were no alternatives.
So there you have it. Home care probably is paid too much on average – but there are areas where resources spent are inadequate. We focus on these areas in our public discussion. Oncology care costs too much, but with no alternative for this new medication, we will keep writing checks.
