Word Games as a Mask for Compulsory Healthcare Equality

January 5, 2011

by Mario Rizzo  

The recent decision by the Food and Drug Administration (FDA) to revoke approval of the drug Avastin for late stage breast cancer is an action with considerable significance for the future of government financed or subsidized healthcare. The FDA pretends to do a risk-benefit analysis and comes to the conclusion that the benefits are not worth the risks.  But since we are dealing with likely terminal cases “risks” must be interpreted with a grain of salt. But, fundamentally, people should be able to strike their own risk-benefit tradeoff, especially in consultation with physicians and due attention to the specifics of their own case. 

The truth of the matter seems to be that the FDA really did a cost-benefit analysis. The cost of the drug, on an annual basis, is $90.000. (It is not clear how many people would live to take it an entire year.) So the real issue is given the cost, is the risk-benefit profile sufficient to warrant taking the drug?  

The significance of the FDA decision is that Medicare, Medicaid, and many private insurers will not pay for non-FDA-approved (“off-label” uses). When ObamaCare fully kicks in presumably the subsidized health insurance policies will not also.  

Now why didn’t the FDA say the use is approved with caution but that because of cost-benefit considerations neither Medicare nor Medicaid would pay for it?  This would have created a political uproar about rationing, death panels and so forth. Instead, they talk about “risks” and make a subjective comparison with benefits that sounds scientific. Thus, the FDA withholds approval of a drug that is simply not good – nothing anyone should want to take. So obviously there is no rationing and no imposition of medical equality. Or so they would have us believe.  

Call the drug too expensive and all hell breaks loose. Call the drug too risky and most people go along with the decision. 

The consequence of this “word game” is that even fewer people will have access to the drug than if the FDA had been honest (that is, approved the drug with caution). However, from a political point of view it is better that fewer people have access to expensive but possibly “low” benefit drugs than more people. The key thing is that the mirage of equal care for all (with its associated “no rationing” in government programs) be maintained. 

The problem in this particular case, to be sure, is ameliorated by the fact that it is still possible to take drugs for off-label purposes. But consider a new drug that has only one use that fails the FDA’s “risk-benefit” standard. It will not be approved and will not be available at all. 

Is the preservation of myths what we have come down to? Is this the plan to save the welfare state?

9 Responses to “Word Games as a Mask for Compulsory Healthcare Equality”


  1. For me, the key point is WHO should do the risk analysis. Third-party funding will always negate individual decisions on these matters, however. He who pays will name the drug.

    Those who can afford it will get the care they demand. If not in the US, then in other countries. Medical tourism is growing and some insurance companies will now pay for it.

    Mexico would be a beneficiary if not for the violence. Costa Rica and other near-by countries will benefit.


  2. […] Word Games as a Mask for Compulsory Healthcare Equality, by Mario Rizzo […]

  3. Roger Koppl Says:

    I think you make a really fundamental point, Mario. I think we tend to underestimate the importance of language. George Orwell did not. Your post inspired me to reread his “Politics and the English Language.” He said, “ready-made phrases . . . will construct your sentences for you — even think your thoughts for you, to a certain extent — and at need they will perform the important service of partially concealing your meaning even from yourself. It is at this point that the special connection between politics and the debasement of language becomes clear.” I am also reminded of Mark Twain’s great short story, “The War Prayer.” If ideas matter, so do words.

  4. Troy Camplin Says:

    Indeed, George Lakoff in fact argues that the Left should engage in such language manipulation to get people to accept what the Left want to do to them.

  5. Roger Koppl Says:

    Troy: What do you mean? I’m sure he does not say that leftist pundits should use hackneyed phrases, dead metaphors, and euphemisms to hide the plain meaning of their policies. So in what sense is suggesting “manipulation” of the language? Does he use the word “manipulation”?

  6. Troy Camplin Says:

    He refers to it as “framing,” but it’s the same thing. He argues that conservatives use it and that progressives should also use it:

    http://berkeley.edu/news/media/releases/2003/10/27_lakoff.shtml

    http://www.huffingtonpost.com/george-lakoff/untellable-truths_b_794832.html

    In the latter he says,

    “Try to imagine how public understanding would have to be enhanced for expressions like the following to come into normal public discourse:

    • greed crisis in place of economic crisis

    • blessed immigrants in place of illegal immigrants

    • government for profit in place of privatization

    • public theft in place of tax breaks

    • failing citizens in place of failing schools

    • corporate cruelty in place of profit maximization

    • deadly coal in place of clean coal ”

    There’s nothing like an honest villain.

  7. Roger Koppl Says:

    Damn! I think we have a winner of the Ellsworth Toohey Prize!

  8. Bill Stepp Says:

    I never realized how vapid Lakoff is. Rothbard would have shredded him to smithereens.

  9. Pietro M. Says:

    Wow, Orwellian Newspeak at its best. Lakoff is right, conning people with words is a great political resource. He is perfectly aware of Confucius dictum “When words lose their meaning, people lose their liberty” (I’m not sure it’s really Confucius, haven’t read him).


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