Cancer drugs fail to win NHS funding

[acsmith]

Source: FT

Four drugs for treating various stages of kidney cancer have been turned down for health service funding in England, in spite of price cuts by the manufacturers.

The decisions by the National Institute for Clinical Excellence underline that new guidance last year for “end of life” treatments will not produce a wave of new approvals for costly drugs that can extend life but where there is not yet evidence of dramatic results.

Read more: http://www.ft.com/cms/s/0/10069bfc-91bc-11de-879d-00144feabdc0.html

---

This is my understanding of a death panel. The panel does not meet to discuss individual cases but decides what drugs will be available on the NHS for everyone. This is a real restriction on the treatment that people can get. Although this example is for cancer drugs the same applies to pharmacutical options for all NHS patients.

It is not quite as graphic as what was being suggested by some people in the US but the restrictions on expensive drugs are definately there in the UK NHS.

[Bonhomme Richard]

1. Gee. I wonder how many approved drugs or treatments are......

available here that the insurance companies refuse to pay for? It's experimental, not proven, not necessary, etc., etc.
Happens all the time right here at home.
I am glad horror stories only happen in those nations that provide universal care. Whoa! Lucky us.
Of course, that's assuming that you have insurance coverage.

[acsmith]

3. I don't know...

...and neither do you. Just wanted to give a little bit of context from the other side of the Atlantic.

[Donnachaidh]

8. there is a LOT of treatments and drugs that are refused here

I had to wait 2 YEARS for an implant because my insurance deemed it *experimental*.

[Name removed]

10. Deleted message

Message removed by moderator. Click here to review the message board rules.

[digidigido]

21. We who seemingly want a civil debate are fairly quick to debase this into name calling

The OP makes a point. You have the choice of dropping the arrogance and anger that feeds the lack of discourse on this issue,
or to be the person who lowers the civility. It may make you feel good, but it's counter productive. IF you really want to
engage with people then be civil. It allows them to hear your point instead of being pissed off that some asshole is calling
them names.

[Name removed]

37. Deleted sub-thread

Sub-thread removed by moderator. Click here to review the message board rules.

[acsmith]

22. the point is that...

...the insurance companies are out to make a buck but a government run system also has to control costs. this has not happened in the NHS over the last 10 years. the government has thrown money at it and achieved improvements in waiting times for operations and increased measures of patient satisfaction but these gains are well below the governments own targets (and to be fair were starting from a very low base).

the NHS is free at the point of use and is great if you don't need serious treatment. otherwise you going to be on the end of a long waiting list. that is the reality.

[enlightenment]

28. That's odd - really.

We must see different systems. I don't live in Britain, but most of the people I know well do. Quite a few of them have needed serious treatments over the years; some longterm for cancers, some for crises that have resolved into longterm management situations, some for non-critical things like knee replacements and such.

Not ONE of them wound up on the end of a long waiting list - both cancer patients were diagnosed and in surgery within a WEEK. The longest time to care was a knee replacement that was delayed because the individual needed to drop a couple stone before the surgery - it took four months to reach the goal weight.

The stories are apocryphal, of course, but as you aren't coming up with any actual statistics yourself, I don't feel inclined to offer anything more.

ALL systems ration and all systems make choices that hinge on greater good.

You don't have to like it, but if you want to argue that the NHS is only good for splinters and bruises, come up with the facts to support your position.

[acsmith]

35. from last year but...

... here is a story from the BBC that makes me think your two friends in surgery within a week were very lucky:

http://news.bbc.co.uk/2/hi/health/7271772.stm

The quote from the Patients Association rep are quite disturbing:

"These figures make us really question whether patients are getting a better deal. What concerns me is that patients with serious conditions may be waiting longer than they used to be. That is wrong."

And remember over the same period the government yearly spending on the NHS went from £34B to £90B.

The Government does publish its version of the waiting times on their website (http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/HospitalWaitingTimesandListStatistics/index.htm) if you want to wade through them.

[muriel_volestrangler]

56. The strange thing is that when you wade through them as I did last week, they've improved

See here: http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=6322480&mesg_id=6343996

(that was for the figures up to 2008; the link you give has them up to June 2009, as "Historical Time-series"). This brings those figures up to date:

Under "Inpatient waiting list data - Provider based", we have:

          Median Mean (weeks)
June 1997 13.4   18.8
June 2009 4.0    5.4

and under "Inpatient waiting list data - Commissioner based":

          Median Mean (weeks)
June 1997 13.6   18.9
June 2009 4.0    5.3

I can't see where the BBC's figures of 41 and 49 days come from. They call them 'Hospital episodes statistics' - what are those?

[SkyDaddy7]

50. That was clearly uncalled for!!

I guess that makes your point valid? "shit for brains"??? Why say that? I guess dif opinions is not your thing huh?

[Gormy Cuss]

17. Every large health insurance company has the equivalent.

The main differences are that it isn't public information and therefore it's far to difficult to predict when and where a potentially life extending procedure or drug will be denied, and there is little regulation to define what constitutes experimental -- leaving it up to insurance companies is how we have many victims like Natalie Sarkasian each year.

When a public entity like NHS makes the determination citizens can rally to influence policy change directly.

[acsmith]

24. the citizens can not change the list

The people that make this list are civil servants and not elected politicians. They can not be held accountable by the citizens. Also, since it is socialised you can not take your premium elsewhere if there is something in the contract you don't like.

I live in Switzerland where there is a very competitive market place for health insurance and you can basically choose what cover you want. When you get sick you get what you pay for. The wages are high here so most people have pretty decent cover. I personally prefer the Swiss system to the UK system (hospitals are cleaner, staff are nicer).

[Doremus]

34. Apparently the Swiss are feeling the economic pinch if its citizens are taking pay to post on boards

Who's paying you?

[acsmith]

40. CERN

it is a particle physics lab in geneva. I am not swiss though I am from scotland.

[acsmith]

45. I didn't think my original post was so controversial

Seems like if you offer an alternative perspective nowadays you have to be paid by someone. I would like to get paid to chat to people on DU all day but unfortunately I don't.

So, who is paying you to be here?

[joeycola]

47. I am sorry to see that a DU member is giving you

a rough time and calling you a troll. It should not be that way at all. Welcome.

[mwooldri]

39. It's hard for citizens to change the list, true.

Likewise it's hard for citizens to change the list of their insurance carrier - their choice is to change insurance companies or change employers or pony up the costs or go without.

These civil servants *are* held accountable by the elected politicians. If the politicans in a review committee decide that certain drugs *must* be covered then guess what? Those civil servants have to do this and enact what those politicians agree upon.

[Gormy Cuss]

51. Uh, didn't say they could change it, but if enough are unhappy with it, polits can change it.

Civil service or not, the funding comes from taxpayers ultimately.

[Wizard777]

27. Yes but being told to go crawl off into a hole and die has a much nicer personal touch coming from a

warm private entity than a cold public entity.

Look at Ted Kennedy and his government provided health care. I've had friends and relatives with private insurance with the exact same Glioma see the exact same doctor Ted did. With the exact same results. They had enough time to say good bye to their loved ones before going down a lil hill that goes off a cliff. It's damn near you're walking around one day, in bed the next and dead the day after that. Not exactly but damn near. The end deterioration is very rapid with very little or no suffering. Who's paying for the approved treatments has no bearing on the medical out come. Usually the problem is getting a person accepted to a medical study group for new experimental treatments. But I have seen hospitals with a heart do what they called a "study group of one."

[Barack_America]

2. "not yet evidence of dramatic results"

Shouldn't the real outrage be the prices pharma is charging for medications that may or may not work, essentially capitalizing off the desperation of cancer patients?

Here's what they cost:
Nexavar is £2,980.47 for 112 tablets while Sutent is £3,363 for 30 capsules and Torisel is listed at £620 per vial.

http://news.bbc.co.uk/2/hi/uk_news/wales/8221720.stm

At least the NHS has pulled back on these drugs in order to provide better established care to more people. In the States our private insurance companies do the same thing, with well established treatments, just to pay their CEO's enormous salaries.

[Gman2]

26. The further outrage is, most drugs are NOT new, they are repatented for new disease

Thereby closing the market to a generic for another many years. I wonder how those outraged at the NHS not using unproven non generics, are as glad that the system allows things like Chiropractor. Perhaps the gov owes everyone seven maids a milking. I would almost rather have the gov take over developing new drugs. Or at least funding. If there is money there, then we should put it back into the system.

[rexcat]

53. That is not the way it works...

If there is a new indication the patent is not extended, in most cases. If the molecule is used for a rare disease the FDA will extend the protection of the drug and extend the patent. If the molecule is changed and there is increased efficacy the new "molecule" will get extended.It is very hard to get an extension on the patent if there was no change to the molecule in question. The bogus part is changing the molecule by one radical group, calling it new and improved formula and then getting an extension of the patent. That is where I have a major issue with the Pharma companies.

I worked on chemotherapy agent for colo-rectal cancer and the patent had a few years to go prior to expiration. The drug had been approved in the EU for some time but not in the US. The company filed a New Drug Application (NDA) with the FDA but only submitted studies done outside the US (no US studies had been done up to that point) and it was rejected by the FDA. The FDA wanted data from a US trial. The FDA worked with the Pharma company and said if they did a US study with a New Drug Application (IND) and resubmit the NDA after the one study was completed they would re-look at the application. The study took about 18 months or so to complete. The data, along with the non-US data was re-submitted and the drug was approved in the US. I do believe that the company wanted an extension of the patent but, as far as I know, there was no extension of the patent. The drug actually does significantly extend life and the FDA did it right in the end by expediting the approval process but there was a lot of compelling data to back up the Pharma company's claims and many people outside the US had already been treated successfully with the drug prior to approval in the US.

[pinto]

4. From what I can see in this slim report, it was a *results based* decision.

And one, Pfizer's Sutent remains approved as a first line treatment but not a second line treatment (i.e. after other therapies have failed.)

This year Nice approved Pfizer’s Sutent as a “first line” treatment for kidney cancer. But the institute has now rejected it as a second line treatment – where an initial therapy has failed – and has turned down rival products from Roche, Bayer and Wyeth for first line use.

[MannyGoldstein]

14. The NHS is Great At Being Evidence-Based

Excellent organization.

[Donnachaidh]

5. costly drugs with NO evidence of dramatic results

Why should any health service just open the doors to expensive meds with NO track record? End of life care is when the real medical vampires come out. And the intention is to suck the insurance dry, while pumping the patients full of meds that do little if anything.

[stopbush]

6. I really don't see a problem here.

The NHS withheld approval because there was no proof that these drugs did anything but provide a very marginal benefit. Set aside the fact that they were extremely expensive - they don't work!

Imagine if the NHS had approved payment for these drugs and they were later found to be totally ineffective or worse? Then, the cries of government complicity with pharma would arise.

This looks like a decision based on the science, and the science doesn't support these drugs. If the drugs had been shown to be effective, that would be a different story.

[dipsydoodle]

42. Exactly

.

[Zen Democrat]

7. Good Lord! What do you imagine insurance companies do here?

Even drugs that have a proven track record of success are not covered by many insurers if the price is over their arbitrary limit. You can get it if you're a millionaire. Otherwise, you're left to suffer. Same in the UK. The ruling class can buy whatever they want, wherever and whenever they want it.

I have every comfort that government decisions on providing experimental drugs would be ever so much more generous than that of insurance companies.

[acsmith]

13. on your final point you are wrong

The mother of a friend suffered from exactly the rigidity that this panel imposes. She went through all of the available treatments for the cancers she had but was willing to try anything that was going. There were "experimental" drugs which were quite promising available on the market which were not on the list because they were too new (read expensive).

In fact the UK has a very bad system for dealing with cancer. This does not mean that socialised health can't do well though since France is a world leader in cancer treatment (my dad was treated for skin cancer there). Their system is semi-socialised with publicly funded and private insurance covering the costs paid upfront by patients. Free at the point of use redeems the UK system somewhat.

[prolesunited]

30. The EXACT same thing happens here with insurance companies

I have a formulary list that I can chose from and if it's not on the list, I'm SOL. I also pay in tiers. Generics are the cheapest, but for some we're just paying out of pocket at Target because $12 for 90 days beats $20 for mail order.

And for some of my asthma meds, like Singular and Advair, there is no generic, but they put it up higher on the formulary so I pay $65 for 90 days on mail order. And, as a result, I under treat my asthma, which luckily hasn't landed me in the hospital, which actually would end up costing the insurance company more.

[Nihil]

57. You are talking pure bullshit.

> In fact the UK has a very bad system for dealing with cancer.

The UK has a fucking GOOD system for dealing with cancer and they
make a damn good job of it.

I have sadly had many friends and relatives who have needed the
assistance of the NHS for various cancers: many have been successfully
treated and have made a full recovery but even the ones who eventually
died were not penalised in any way by the fact that the state was paying
for everything rather than an insurer.


> "experimental" drugs which were quite promising available on the market
> which were not on the list because they were too new (read expensive).

"Experimental drugs" would not be on the market unless the manufacturer
deemed that they could appear "quite promising" so the first part of
your statement is totally redundant.

Drugs have to provide a genuine benefit *in real life* before they can
make "the list" - regardless of their expense - so your second part is
simply wrong.

One of my friends eventually asked NOT to be given another "promising"
experimental drug as all that the preceding ones had done had falsely
raised the hopes of her family whilst saddling her with even more side
effects for zero gain - actively *decreasing* the quality of her life.
*THIS* is part of the reason why drugs that are not proving beneficial
are kept "off the list", not expense per se.


Putting the various inaccuracies of your post together and taking them
with most of your other comments on this thread, it is not at all surprising
that some people call you a troll as that is the unfortunate appearance
that you present.

[Name removed]

9. Deleted sub-thread

Sub-thread removed by moderator. Click here to review the message board rules.

[Hell Hath No Fury]

11. FYI, the FT is --

a very, very conservative paper whose rich readers probably don't like the NHS on principle.

And that kind of "rationing" of treatment -- that already haapens here with private insurance and with Medicare. :shrug: My Mom was able to get one MRI for a conditiona and was turned down for a second one wanted by another doctor for the same condition.

People in the UK seeking treatment for kidney cancer will get treatment -- with the medication that has been determined to be the most effective for the situation.

We should all be so lucky.

[acsmith]

15. actually

...the FT is one of the only newspapers left in the UK that has its integrity left. the Guardian lost its when it changed its tune on the war in iraq. the Times was bought by murdoch. the Telegraph is the truly conservative paper. the only other paper that is worth the ink is the independent which many people find condescending.

[Hell Hath No Fury]

20. It is a conservative paper for the monied.

and it is reflected in their work. :shrug: Sorry, but you can't get away from that.

[acsmith]

23. but your point was

...that the FT is against the NHS in principle. During the affront on the NHS in the last months it has shown it is not.

[mwooldri]

43. Nope, FT is a conservative paper whose READERS may be anti-NHS.

FT really isn't that bad and you are right that it does have some "integrity".

The Independent has actually appeared more Liberal Democrat than most.

It's OK that the Guardian and Observer have changed their stance on the Iraq war, after all I was misled about it too.

Mark.

[MannyGoldstein]

12. More People Will Live More Years Because Of This Decision

The NHS's job is to maximize the good work that can be done for a given expenditure.

Suppose a drug will slow one person's death for a month at a cost of $1,000,000. That same $1,000,000 could perhaps save two years of life for each of 20 recipients of an ICD (implantable defibrillator). Where would you choose to spend the $1,000,000?

Given that we can't spend 100% of GDP on healthcare, we need to make choices. Actually, even if we could spend 100% of GDP on health care, we'd need to make choices.

[Warpy]

16. Perhaps it's not as stark as you think it is

If these drugs extend life but don't offer a cure, by how much is life extended? How is that life extended, which means what kind of side effects do these drugs have? In other words, are they extending life or prolonging death?

These are the kinds of questions medical people have to ask all the time and it's why a normally functioning "death panel" routinely denies things like heart transplants to patients over 80 years old. They might survive the surgery, but they'll be far worse off than before it. They might get a little time, but that time will be spent sick and quite probably with post surgical dementia.

Cost isn't the only factor in deciding whether or not new treatments are approved or old treatments are applied.

[Rosa Luxemburg]

18. unless they cure they extend suffering

unless it is a clinical trial maybe. This is always a tricky one because people with cancer try to leave no stone unturned in the hope of a cure.

[Warpy]

48. Exactly, and the desperate search for a little more time

ruins what little time they have left.

That's what I mean about prolonging death instead of prolonging life.

[JeanGrey]

59. Of course they do, and that is why for instance, breast cancer

is no longer a death sentence for most people!!

[acsmith]

25. I didn't want to mention it before because I thought it was irrelevant

But there are things like you describe that limit (for example) liver transplants to people who drink, lung transplants to smokers etc. Of course similar discrimination is made against aging (or already old) people.

[SemiCharmedQuark]

60. that has nothing to do with the system. That is because there is a shortage of organs.

We also limit who gets organs here. There simply are not enough organs to go around.

[JeanGrey]

58. I possibly can answer that. I have stage four cancer that

started on my liver, due to needing a liver transplant and not getting it in a timely manner. That was in January of 2004. I did get the transplant, the cancer came back in 06, and my oncologist has spared NOTHING in throwing every arsenal at it my cancer and I am now on my fifth line of chemotherapy, in 2009 and I AM STILL HERE. I belong to several cancer boards where it is NOT unusual to see stage four cancer patients living five or ten years....................

It chills my blood when people start talking about "deciding" which people we should spend the money on for treatment.

I had six years I would not have had and believe you me, they meant EVERYTHING to me. It would mean everything to YOU.

[Cleita]

19. Our private insurers do the same. n/t

[acsmith]

29. I am sure they do...

...but I get the impression that in DU people really think that a system like the NHS would make levels of care better in the US. There are two different things which get confused in my opinion:

1. Number of people with access to health care (not insurance). Which I expect would go up.
2. The average level of care (not insurance premiums) which I expect will drop.

The two are really different and perhaps higher 1 with lower 2 is not so bad. But, it means that there will be a drop in levels of care for people that already receive it.

[Mark D.]

32. Based On What?

Please give a basis for your claims. Why will care drop. Rush told you so? Other than the UKs shining examples of these sort of problems, such examples are more rare in places that have single-payer care (and NOT a national health system, which is very different). A Google or YouTube search of Health Care and Sweden, Scandinavia, Japan, etc., will net far more against your arguments. The aforementioned have longer lifespans, lower crime, higher IQ, lower teen pregnancy, lower STDs, lower drug use, lower infant mortality, more healthy seniors, lower drop-out rates, and far more people fully satisfied with their health coverage, than America.

It's hard to beat, thus the desperate searching in one of the worst example nations for universal care, skipping over the ones that beat your argument in every way. Systems that have been in place for decades, close to a century in some cases. What's the big picture? It's part of a system of well-regulated capitalism with a few aspects of proper socialism. People-first kind, not state-Communism style, always what the right-wing throws at the ignorant to scare them that ANY effort to help the common citizen will lead to that.

What is noted, and has been noted on DU more than once, is the more that a nation invests in its people, paid for with a slightly higher tax on the middle class (far less than the huge savings on premiums, co-pays, and deductibles, and other not-covered out of pocket) and somewhat more higher tax on the wealthy. Yet wealthy live in those nations! Why? They like forgetting to lock their front door and not having to go all the way back home for fear some poor person, or victim of the 'war on (the poor, minorities especially) drugs', will break in. They like not having to drive down the street and see so-called 'Christians' stepping over homeless veterans on their way to picket an abortion clinic. They get what they pay for.

[Cleita]

41. Most of us don't want NHC like you have in Britain.

We want Medicare for all, which would be an extension of our single payer system for senior citizens. If it isn't messed with by conservatives, health care is delivered in the private sector but taxes collected and health care costs paid by the government. Since our conservatives screwed the pooch with the prescription drug benefit, we certainly don't want it the way it stands. If it's done right the only restriction in drugs is you may have to get generics if they are available and the government would bargain for lower prices, but I don't think there would be any other restrictions like you describe. Of course if a drug is experimental and not available because it hasn't been tested, you can volunteer in this country to be a guinea pig for testing. I have done it in the past when I needed asthma medication but couldn't afford it.

[Mark D.]

31. A Few Things

1) Others have repeatedly pointed out that our insurance companies here do this kind of restriction far more often. There are thousands of proven cases of this. You seem to have overlooked those. Please explain how it's somehow better when a profit-minded corporate tool does it, even more often.

2) You said France does it better. Are you saying you'd support a single-payer system like France has? Answer with yes or no, or yes, if that was slightly modified in some way. Don't dodge it. Explain what YOU would like to see done to improve things, vs. merely arguing against those trying to fix it.

3) Understand the anger here. There have been a lot of 'new people' here curiously bringing up every story they could find against health care reform, folks will get suspicious of it in time. We see the same pattern enough, we start to wonder about these 10-70 or so post people appearing so suddenly.

4) My mother fought with the 3rd largest insurer in America who denied my late father's admission to a hospice when he was terminal and unable to be cared for at home. They defined 'hospice' as a visiting nurse. Bastards. It took the wrangling of a 'bureaucrat' (our State Rep.) to get that resolved.

He's there to help us, insurers, to help themselves. It's all true, the denial of claims for profit, getting those who are the most uncaring promoted and those who care too much demoted. Michael Moore isn't making it up. I've worked at more than one health insurer, and have doctors as friends. I know.

[Gman2]

33. IT is far better to hash this out among friends, than in the media.

[acsmith]

38. .

1) This is kind of the point in a round about way. People hope that when they get their new health care system it will not have these restrictions when it certainly will have. More of a warning about getting hopes up than anything else.

2) Yes, the French health care system is better than what you have now. But then you would have to pay French taxes (which are VERY high). The major thing about France is that the state owns/runs the universities which train the doctors and performs the medical research. I don't think you could pull it off in the US where doctors have to make a lot of money just to pay back their loans (although I am happy to be wrong on that).

3) I have been around for a while, just because I have a low post count doesn't make me a nut-job. Frankly, I see many people who just post things like "crazy nut-wacko manics just fuck off" more often than not to anyone that offers the alternative position. I could start doing that to get to 1000 posts but I am sure you agree that is a bit pointless. Of course others are willing to discuss.

[Mark D.]

46. Thanks

For your reply. Trouble is, 90% of the anti-reform posts are by under 60 or so posters. Again, it doesn't indict you, but try to understand.

Again, you get what you pay for. France pays more taxes, but the average family saves vs. America where the average family spends 12-14 thousand a year on all health care related costs. You want a stimulus? Picture millions of families with 10-15 thousand a year more spending money. FAR less than the increased taxes.

It's been proven, administrative costs are 1/3 of what America spends on health insurance now in the disperate plans (Medicare, Medicaid, Vets, etc.). Combined, without that 1/3 going to private insurers who's main goal is profit, we could cut that cost in half. Paying 350 billion LESS than we do now to cover everyone.

There are restrictions in EVERY possible system. That's stating the obvious. The difference is this. Take profit out of it, take multi-million CEO salaries out, you have more left over for care. A govt. plan would NOT be trying to make a profit. That difference alone is huge. There's something else you have overlooked.

Deficit spending. We don't like it. I like to live within my means. I have to. The government has done it a lot. Whether it be for wars based on lies by Bush or Reagan's build up against 'big red'. If the budget was a little over one year, we'd survive. The ability to get fair drug prices, to cut those wasteful administrative costs, and so much more, would cut the total cost of health care, not increase it. Yes, in time, as the population grows and ages, the cost will go up. The cost for EVERYTHING goes up. That's how it is. We will have more people with jobs, paying taxes, increasing the budget.

The simple fact is this. Our health insurance system is a Libertarian model. Those who can afford get, those who can't, it's not my problem. EVERY OTHER industrialized nation, for years, decades, even near a century, have had single-payer plans in place. Imperfect, they have their problems EVERYTHING DOES and NONE COMPARE to ours here. Yes, they have to deal with cost issues sometimes. But you get far more rationing and denial of care in America under a private insurer than you do in places that have single-payer systems in place done correctly. Investigate Japan or Scandinavia. You'll see it yourself.

I've recently seen a FOE of the 'public option' get BEHIND the idea of single-payer, based soley on what he learned of the systems in Japan and Scandinavia (which by all major factors of what makes life better I mention above, do far better than we do). He was objective. You're very determined NOT to see those benefits. Point at the few possible flaws, and ignore the worldwide track record that single payer is better.

[acsmith]

49. don't get me wrong

I am not for the US health care system as it stands now. It is a joke to the rest of the world (as it is to most people on DU also). But no-one would deny that for those that can pay it is the best in the world, second to none.

There are some things that the US just can't do. It can not be Sweden or Norway or Finland. It just can't. The system in those countries is set up from bottom to top to give safety nets for everyone. People there pay lots in taxes but their governments don't spend 2/3 of their money on fighter planes. They have reliable public transport, free health care and tertiary education, humane unemployment benefits and are basically socialist utopias. But, that is not what the US is, never has been, never will be. The political system is just too far away from that. The most right leaning politicians in those countries (apart from the anti-immigration crowd) can't even hold the left hand of any member of the Democratic party. Your political system, its values and its constitution are just not compatible with what you see in those countries. Unless you are willing to start a revolution you will not get there either (probably not a good idea either since the republicans have all the guns).

You wonder why so many people want to move to the US and why every visa auction goes oversubscribed so many thousands of times? It is because the opportunities in the US are greater than any other country can offer. It doesn't always work out for people but, in coming to the US they are willing to take that risk.

[tomm2thumbs]

36. bottom line: it wasn't beneficial so why pay money for it

“the benefit was still too small, set against their cost”.

For $30 million dollars I can replace all your organs and put you in a brand new body so you will live forever. Let the tax payers foot the bill.

[mwooldri]

44. Some of these drugs are as useful as those Bridges in Alaska...

they go nowhere.

Mark.

[JeanGrey]

52. Oh, it would be "graphic" enough for me.

I'm a stage four cancer patient. Depends on what side of the fence you are looking over.

[dugaresa]

54. to be honest, I don't see what is wrong with restricting funding for

a drug that may be more expensive and do the same thing that perhaps 10 other drugs do and it makes more sense if that drug is more expensive and perhaps isn't as affective as marketed.

If I put out a drug that is similar to aspirin but i just add some vitamin a to it, it may make it a bit different but for all purposes it is still aspirin and does not warrant the high costs I may want to charge for it. -refusing to cover that kind of drug is "common sense"

[Dutch]

55. So instead of admitting that "Deat Panels" don't exist, you're redefining what constitutes one?

In that case, as has been repeatedly pointed out, US insurance companies are its past masters.