It's one thing to say there's a shared obligation not to let people suffer or die when we know how they could live many years longer, or in much less pain. I find it a whole lot less compelling to suggest that people are entitled to public provision of, say, Tacerva—which . . . was approved to treat pancreatic cancers because it improves survival time by a whopping 12 days at a monthly cost of $3,500.
This, I think, is the basic problem with health care reform. If you were dying from pancreatic cancer and you could pay $3,5000 to extend your life by 12 days, wouldn't you do it? I certainly would. From an individual perspective, this seems like an entirely rational decision. But from a social perspective, does it really make sense?
If we want to consider health care reform, I think we have to begin talking about rationing. Unfortunately, Republicans are only interested in using the idea of rationing as a scare tactic, while most Democrats refuse to even speak the word . . . .
Update: Megan McArdle has a long-winded post on this. I think she's right that it's a bit silly to frame the question this way -- these drugs don't expand everyone's live expectancy by 12 days, rather they extend the average life expectancy by 12 days.
Thus, some people may enjoy a few extra months of life, while others may die sooner because of an adverse reaction to the drugs. The point is that when you're facing death, a chance to prolong your life even by a few days (and possibly a few months) is probably worth it. The possible upside benefits of the treatment far outweigh the potential side-effects. And it's not easy to deny people drugs that could potentially extend their last few days of life.
I'm not saying that this is the standard we should adopt. But I actually think that it has a fair amount of emotional resonance, which is why appeals from cancer patients are so effective when they're denied marginal treatments.
I'd say that's true. And I suspect cost becomes less of an issue for these patients as they approach the end of their lives.