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Rational Rationing

There’s a great piece in the coming Sunday Times Magazine on rationing health care. How can we weigh the costs of health care without, ultimately, putting a value on human life? We can’t, really, but we can devise a better scale. Philosopher Peter Singer shows us how, with “the quality-adjusted life-year, or QALY, a unit designed to enable us to compare the benefits achieved by different forms of health care.” This presupposes that we will accept the rationing of care, to which many people strenuously object. However, we already do ration care: some people can afford it, or are covered by existing government plans, and others have to take their chances without any kind of insurance. Before anyone starts banging on about how hospitals can’t refuse to treat people, consider this:

But even in emergency rooms, people without health insurance may receive less health care than those with insurance. Joseph Doyle, a professor of economics at the Sloan School of Management at M.I.T., studied the records of people in Wisconsin who were injured in severe automobile accidents and had no choice but to go to the hospital. He estimated that those who had no health insurance received 20 percent less care and had a death rate 37 percent higher than those with health insurance. This difference held up even when those without health insurance were compared with those without automobile insurance, and with those on Medicaid — groups with whom they share some characteristics that might affect treatment. The lack of insurance seems to be what caused the greater number of deaths. …

Doyle’s figures suggest that if those Wisconsin accident victims without health insurance had received equivalent care to those with it, the additional health care would have cost about $220,000 for each life saved. Those who died were on average around 30 years old and could have been expected to live for at least another 40 years; this means that had they survived their accidents, the cost per extra year of life would have been no more than $5,500 — a small fraction of the $49,000 that [an independent health system guidance committee] recommends the British National Health Service should be ready to pay to give a patient an extra year of life. If the U.S. system spent less on expensive treatments for those who, with or without the drugs, have at most a few months to live, it would be better able to save the lives of more people who, if they get the treatment they need, might live for several decades.”

So, we’re rationing care in the worst way possible, chance. We let people who cannot afford the often exorbitant price of health insurance die simply because they don’t have it. Not only that, but we allow plenty of people who’ve scraped together enough to pay for insurance to suffer because they can’t afford the costs of their care – be it doctor’s visits or medications – on top of their premiums.

Even those who don’t want to assign life a value would have to agree that we can do better than our current system.

The QALY is not a perfect measure of the good obtained by health care, but its defenders can support it in the same way that Winston Churchill defended democracy as a form of government: it is the worst method of allocating health care, except for all the others. If it isn’t possible to provide everyone with all beneficial treatments, what better way do we have of deciding what treatments people should get than by comparing the QALYs gained with the expense of the treatments?”

I’d rather lose out on an expensive life-prolonging (not -saving) treatment because of calculations that consider everyone impartially than get an aneurysm because I had to choose between my son’s inhaler and my lisinopril. Wouldn’t anyone? Wouldn’t an approach like this be better than some impotent group that can compare costs and benefits of various treatments but can’t enforce the findings? Couldn’t we combine private insurance with a stronger public option? Singer points out that Australia does, and we could by

extending Medicare to the entire population, irrespective of age, but without Medicare’s current policy that allows doctors wide latitude in prescribing treatments for eligible patients. Instead, Medicare for All, as we might call it, should refuse to pay where the cost per QALY is extremely high. … Every American will have a right to a good standard of health care, but no one will have a right to unrationed health care. Those who opt for unrationed health care will know exactly how much it costs them.”

Sign me up. I’m currently paying a ton and am unhappy with what I get. Imagine if I had another choice?

3 Comments

  1. Louie

    July 16, 2009 at 1:55 pm

    we have had rationing for years although its not discussed. It’s called geographic rationing.

  2. […] The Progressive Pulse – Rational Rationing By Andrea Verykoukis How can we weigh the costs of health care without, ultimately, putting a value on human life? We can't, really, but we can devise a better scale. Philosopher Peter Singer shows us how, with “the quality-adjusted life-year, or QALY, … So, we're rationing care in the worst way possible, chance. We let people who cannot afford the often exorbitant price of health insurance die simply because they don't have it. Not only that, but we allow plenty of people who've scraped … The Progressive Pulse – http://pulse.ncpolicywatch.org/ […]

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