About a year and a half ago, I wrote an article for the American Spectator about a formula for pricing out your life called the “quality-adjusted-life-year” (QALY). It is, essentially, a tool that government bureaucrats like Donald Berwick want to use for purposes of rationing medical care:
[QALY] assigns a numerical value to a year of life. A year of perfect health, for example, is given a value of 1.0 while a year of sub-optimum health is rated between 0 and 1 … All that remains is to assign a specific dollar value to the QALY and, voilà, your life has a price tag.
Due to public concerns about rationing, PPACA forbids the use of QALY “as a threshold” for determining what sort of health care is recommended. But progressive health care wonks have not abandoned their crusade. The latest edition of NEJM features a piece pimping QALY:
QALYs provide a convenient yardstick for measuring and comparing health effects of varied interventions across diverse diseases and conditions. They represent the effects of a health intervention in terms of the gains or losses in time spent in a series of ‘quality-weighted’ health states.
And the authors go on to suggest that government health care bureaucrats at Health & Human Resources and the Centers for Medicare & Medicaid Services should not take PPACA’s proscription against QALY too literally. They are very concerned about resources:
The use of explicit, standard metrics such as cost-per-QALY ratios has the advantage of transparency and can help direct our resources toward the greatest health gains … It would be unfortunate if the ACA created a barrier to their development and use.
In other words, it would be “unfortunate” if HHS and CMS followed the law. Much better to use QALY to “help direct our resources.” What these ghouls mean by “resources” is medical care. And they want to “direct” these ”resources” away from patients who will die without them.
[ht ECM]
Comments 2
OK Professor Catron, how would you do better than world experts on health assessment, who agree that QALYs are an effective tool? As the NEJM paper says: ‘QALYs simply give priority to interventions that offer the most health benefit in terms of measures people care about — more time spent in good health.’ How would you decide on effective interventions?
Posted 18 Oct 2010 at 2:47 am ¶QALY has been used for decades in the automobile industry for determining the cost effectiveness of safety innovations. For example, widget X can theoretically save 5 QALYs per year, but would add $2000 to the sales price of the car. Mgmt would make a “go-no go” decision based on an internal threshold. The health and life insurance industries also use QALY in their calculations.
While distasteful to calculate the “value” of an individual, if it’s *my* tax dollars on the line vs. the patient’s own funds, I want to get bang for my buck.
The whole government health care system is about rationing, one way or another. Somebody gonna lose. Look for those who don’t have a voice with the Progressives to be making a quick trip to the undertakers.
Posted 18 Oct 2010 at 6:14 am ¶Post a Comment