The first issue is whether the NHS should provide medical services for cancer patients willing to pay for Avastin or other high cost drugs themselves. Alan Johnson (health secretary) pledged to review “top-up payments”. Previously, he contended that the practice would break the NHS principle of equal access. The British have always had a parallel private health insurance system and private doctors and hospitals for those that could afford to pay up.

The second issue that the FT surfaced is whether cost-benefit stifles innovation. Harpal Kumar, head of charity Cancer Research states that most cancers are cured through surgery and radiation – not drugs. NICE agrees, and further states that advanced drugs only extend life by a few months.

The biotechnology industry counters that they must be paid huge sums for small innovations to promote expensive research. Progress is in slow and steady steps, with very few dramatic breakthroughs. The industry claims that traditional cost-benefits should not apply.

I gained an important insight into our own American health system. It seems that Americans have only two choices in health insurance: all-inclusive, catastrophic insurance and limited benefit plans. Both types of insurance typically include high cost hospital administered drugs. The only difference is that limited benefit plans have a lifetime cap of $30,000 to $50,000.

We Americans would be better served if our private health insurers adapted a cost-benefit based third option. This middle ground modeled after the British system would be far better than low lifetime caps. Give insurance buyers the option of foregoing extremely expensive end of life treatments for substantially lower premiums. The side benefit is that eliminating high cost drugs from most insurance plans would force these drugs to be more competitively priced.

I know critics will complain that I am proposing a two-tier healthcare system, where only the wealthy get advanced treatments. I say “get real”- all or nothing is certainly not working.

No Disclosures.