Quality Adjusted Life Year

by Rober Tracinski, editor www.TIADaily.com

"When the government takes over health care and bans private health insurance,
what can we expect? We can expect rationing of medical care.

In fact, in the New York Times article below, leftist utilitarian philosopher
Peter Singer openly advocates rationing. He does it by arguing that health care
is already "rationed" in the free market, it is just "rationing by price."

This is an inexcusable abuse of the language. "Rationing by price" is a
contradiction in terms, because prices are the opposite of rationing.

The essence of a price is voluntary exchange. A price is the result of a
negotiation between a willing buyer and a willing seller, with each party acting
on his own judgment about his best interests.

So if you decide to pay lower premiums for less extensive insurance coverage, or
to forgo an extremely expensive treatment that will only extend your life by a
few months, so that you can leave more of your savings to your loved ones, these
vital decisions are under your control and are directed according to your
judgment of the risks and of the relative values involved.

You are never denied care-if you are actually willing to do what is necessary to
obtain it.

Prices are implicitly based on an ethics of individualism-the idea that it is
the individual's right to make his own decisions and his responsibility to
support himself.

Rationing, by contrast, is an artificial shortage created by coercion.

It consists of the government telling you that you cannot have certain kinds of
medical care because some board of bureaucrats has decided that it is not
"cost-effective."

Rationing is implicitly-and explicitly-based on an ethics of collectivism.

I don't recommend reading the whole article below, because reading a
contemporary philosopher is like sticking your head in a cotton candy machine.
But if you do choose to read it, you may notice that it never looks at medical
care from the perspective of the individual making rational decisions about
costs and benefits for his own life.

It always implicitly looks at health care from a collectivist perspective: the
perspective of bureaucrats making decisions about the cost of your medical care
"to society."

The term that sums up this collectivist outlook is the "quality adjusted life
year"-the pseudo-mathematical term for a government bureaucrat's decision
concerning whether your life is worth continuing or not, based upon your age,
your prognosis, and some bureaucratic formula that quantifies your "quality of
life."

"Quality adjusted life year" is the term that tells you that the most profound
decisions concerning your own life have been taken out of your hands. Get ready
to hear it a lot- and to live and die by it- if Obama and the Democratic leaders
in Congress get their way.


"Why We Must Ration Health Care," Peter Singer, New York Times, July 15

http://tinyurl.com/ox7g6k

"You have advanced kidney cancer. It will kill you, probably in the next year or
two. A drug called Sutent slows the spread of the cancer and may give you an
extra six months, but at a cost of $54,000. Is a few more months worth that
much?
If you can afford it, you probably would pay that much, or more, to live longer,
even if your quality of life wasn't going to be good. But suppose it's not you
with the cancer but a stranger covered by your health-insurance fund. If the
insurer provides this man-and everyone else like him-with Sutent, your premiums
will increase.

Do you still think the drug is a good value? Suppose the treatment cost a
million dollars. Would it be worth it then? Ten million? Is there any limit to
how much you would want your insurer to pay for a drug that adds six months to
someone's life?

If there is any point at which you say, "No, an extra six months isn't worth
that much," then you think that health care should be rationed.

In the current US debate over health care reform, "rationing" has become a dirty
word….

Health care is a scarce resource, and all scarce resources are rationed in one
way or another. In the United States, most health care is privately financed,
and so most rationing is by price: you get what you, or your employer, can
afford to insure you for.

But our current system of employer-financed health insurance exists only because
the federal government encouraged it by making the premiums tax deductible. That
is, in effect, a more than $200 billion government subsidy for health care. In
the public sector, primarily Medicare, Medicaid and hospital emergency rooms,
health care is rationed by long waits, high patient copayment requirements, low
payments to doctors that discourage some from serving public patients and limits
on payments to hospitals.

The case for explicit health care rationing in the United States starts with the
difficulty of thinking of any other way in which we can continue to provide
adequate health care to people on Medicaid and Medicare, let alone extend
coverage to those who do not now have it. Health-insurance premiums have more
than doubled in a decade, rising four times faster than wages.

In May, Medicare's trustees warned that the program's biggest fund is heading
for insolvency in just eight years. Health care now absorbs about one dollar in
every six the nation spends, a figure that far exceeds the share spent by any
other nation….

Rationing health care means getting value for the billions we are spending by
setting limits on which treatments should be paid for from the public purse. If
we ration we won't be writing blank checks to pharmaceutical companies for their
patented drugs, nor paying for whatever procedures doctors choose to recommend.
When public funds subsidize health care or provide it directly, it is crazy not
to try to get value for money.

The debate over health care reform in the United States should start from the
premise that some form of health care rationing is both inescapable and
desirable. Then we can ask, What is the best way to do it?...

This is the basis of the quality-adjusted life-year, or QALY, a unit designed to
enable us to compare the benefits achieved by different forms of health care.

The QALY has been used by economists working in health care for more than 30
years to compare the cost-effectiveness of a wide variety of medical procedures
and, in some countries, as part of the process of deciding which medical
treatments will be paid for with public money.

If a reformed US health care system explicitly accepted rationing, as I have
argued it should, QALYs could play a similar role in the US...

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