Dr. Ezekiel Emanuel proposed eliminating out-of-pocket costs for cancer patients in the United States
Quoting on Linkedin,” Dr. Ezekiel Emanuel, an oncologist, author and co-director of the Health Care Transformation Institute, recently proposed eliminating out-of-pocket costs for cancer patients in the United States. Emanuel’s idea is that, once diagnosed, patients would be deemed to have reached their out-of-pocket maximum. He identifies the lack of a moral hazard in seeking cancer care that is often used for the justification of high deductibles and coinsurance for those seeking routine care. Furthermore, Emanuel argues that the demand for cancer care is relatively inelastic and is largely determined by the physicians treating the cancer.
Some progressive employers have adopted policies similar to Emanuel’s proposal in exchange for patients electing to participate in Centers of Excellence programs. In many cases, these employers include support for non-traditional out-of-pocket costs, like transportation and lodging.
It’s worth looking beyond the eye-catching headline of his op-ed. Emanuel advocates for full coverage of evidence-based and most cost-effective treatments. He cites the management of bone metastases and radiation therapy for prostate cancer as areas where more cost-effective care would be covered at full cost. However, other therapeutic options may actually have out-of-pocket costs for patients.
This trade-off is not necessarily unreasonable, but it’s certainly something we’re not used to in America. We are watching the early growing pains of the Inflation Reduction Act, which, in broad strokes, trades off limiting out-of-pocket cost for Medicare members in exchange for price negotiation on drug therapies which have the highest cost impact to Medicare. It’s clear that not everyone is entirely on board with this trade-off, and we might find the same challenges in Emanuel’s proposal. I would imagine provider systems that have invested in proton therapy might not be as excited about his ideas as others.
Finding the right path to limiting financial toxicity for cancer patients – not to mention all patients with chronic diseases – is a righteous goal but will require compromises from a variety of stakeholders. I’m sure Emanuel is familiar with the prisoner’s dilemma, a relatively simple game theory problem that suggests we are all better off when we cooperate, but individually we might be better off not cooperating. We will have to figure out how to get nearly all stakeholders on the same page before we make real meaningful changes in the challenges of financial toxicity for cancer patients.”