The New York Times begins to soften us for health care rationing.
“Eventually, we may well have to decide against paying for expensive treatments with only modest benefits. But given how difficult that would be for this country, it makes sense to start with the easier situations — the ones in which “no” really is the best answer for patients. ”
Ever heard of a QALY?
Quality Adjusted Life Years is a mechanism for rationing health care. Obamacare provides a “panel” to decide on the treatments allowed to a patient based on the treatment’s “return on investment.”
How To Decide Who Will Receive Certain Treatments – An Explanation of QALY’s
“Health-care experts say that the era when doctors offer most insured patients the most expensive, aggressive treatments is fast coming to an end. Rationing is looming.”
The scale is called quality-adjusted life years, or QALY’s (pronounced QUAL-eez). QALY’s provide answers to questions like, If money is limited, is it a better value to pay for a hip replacement, a coronary artery bypass operation or a kidney transplant?
“I think we definitely will go this way for the simple reason that we must ration health care,” said Dr. Uwe Reinhardt, a health-care economist at Princeton University. Dr. Arthur Caplan, director of the Center for Biomedical Ethics at the University of Minnesota, agreed. “QALY’s are inevitable,” he said.
With health-care costs soaring and with growing demands for more access by more people to health care, economists and policy planners say the nation has to find ways to decide which treatments will be paid for and which are not worth their costs.
The way QALY’s are calculated involves a mathematical model that assigns a numerical “score” to certain qualities of life. The scores were determined by asking healthy people how they would rate certain health situations. Of course, QALY’s by design score “other people’s” health situations. The patients themselves have no personal input.
“Even supporters of QALY’s said they had some qualms about the rating system. Dr. Reinhardt wonders who should be doing the quality-of-life ratings. People who are healthy are more likely to assign a low score to a life of disability than are the disabled. “We all talk bravely — ‘I’d rather be dead than be in a wheelchair’ — but if you ask people in a wheelchair, they’ll give you a very different answer,” he said.
Dr. Caplan, who generally supports the notion of QALY’s, said that at the heart of these objections is the feeling that QALY’s “leave no room for the sanctity” of life. “There is no way we will not rank people very low if they have severe disabilities or are in comas or are severely retarded,” he said.
“To measure the value of a treatment, a QALY calculation asks how long the person will live after having the treatment, and then multiplies each year of life after treatment by its quality. The value of a year of life is weighted from zero to one, with zero as death and one, perfect health with no disability. If a person lives for 10 years with a minor disability, measuring 0.8 on the QALY scale, the years are discounted to the equivalent of eight non-disabled years.“
Ethicists Struggle to Judge the ‘Value’ of Life, GINA KOLATA, The New York Times, November 24, 1992
Examples of Rationing
“That the British medical system’s rationed failures have not created more of a stir on this side of the Atlantic is indeed testimony to the bureaucracy’s campaign of propaganda and disinformation.“
Rationing Health Care: Price Controls Are Hazardous To Our Health, The Independent Institute, February, 1994
- Britain’s National Institute of Health restricts access to common drugs to treat Alzheimers, such as Aricept. This practice was upheld in a 2007 legal ruling.
“It was a legal ruling greeted with relief at the offices of the National Institute for Health and Clinical Excellence (NICE) but bitter disappointment” to treatment proponents. “After 10 months of legal wrangles, a London court upheld the institute’s decision to restrict access to drugs for Alzheimer’s disease.”
Despite many areas of rationing based on cost, Britain’s National Institute of Health has done a poor job of controlling the costs that it promised to control.
“Just how successful NICE has been is open to question. Harris is among those who criticise it as a crude rationing body. Others, conversely, point to its failure to control escalating drug costs. Between 2000 and 2005, the UK’s pharmaceutical expenditure as a proportion of gross domestic product (GDP) rose by an average of 7·3% a year. This figure compares with an annual rise of 7·7% in the USA and 10·8% in Canada between 1999 and 2004, but with rises of 6·0% and 6·7%, respectively, in Germany and France.”
- In Manitoba, which is my former home province, the premier–the political equivalent of a governor–concedes that his pledge to end hallway medicine has fallen short. Hallway medicine is the phenomenon where the emergency rooms are so filled with patients that people are forced to lie on stretchers in hallways, often for days. Overcrowding is a periodic problem. In fact, the overcrowding is worse than last year. The community is rocked by the death of a 74-year old man who had waited in the emergency room for three hours and had not been seen.
- New Brunswick announces that they will send cancer patients south to the United States for radiation therapy. New Brunswick, a small maritime province, is the seventh to publicly announce its plans to send patients south. In the best health care system in the world, the vast majority of provinces now rely on American health care to provide radiation therapy. Provinces do this because the clinically recommended waiting time for treatment is often badly exceeded. Ordinarily, oncologists suggest that there should be a two-week gap between the initial consult by the family doctor and the referral to the oncologist, and then two weeks more from the oncologist to the commencement of radiation therapy. In most Canadian provinces, we exceed that by one to two months, sometimes three.
- In Alberta earlier this year, a young man dies because of the profound emergency room overcrowding. He is 23. On a winter’s night, he develops pain in his flank and goes to the local emergency room. It is so crowded that he grows impatient and goes to another. There, he waits six hours. No one sees him. Exhausted and frustrated, he goes home. The pain continues, so he finally decides to go to the local community hospital. It’s too late: His appendix ruptured. He dies from the complications hours later.
- The head of trauma care at Vancouver’s largest hospital announces that they turn away more cases than any other center in North America. He’s quoted as saying this would be unheard of in the United States.
“The book, Ecoscience, was co-written with neo-Malthusian prophet of doom and scientific laughingstock Paul Ehrlich. In it, Holdren advocates a series of bizarre and horrifying measures to deal with an overpopulation threat that never materialized.
Among the suggestions in the book: Laws requiring the abortion or adoption of illegitimate children; sterilizing women after having two children; legally requiring “reproductive responsibility” to those deemed by pointy-headed eugenicists to “contribute to general social deterioration”; and incredibly, putting sterilizing agents in the drinking water.
Naturally, these population control measures would be enforced by “an armed international organization, a global analogue of a police force.” Very recently, Holdren was still listing the book on his C.V.”
HOW EUTHANASIA RELATES TO HEALTH CARE REFORM:
Since its inception, the pro-life movement has been as concerned with protecting older people and people with disabilities from euthanasia as with protecting unborn children from abortion. It has recognized that denial of lifesaving medical treatment, food and fluids against the will of a patient is a form of involuntary euthanasia. When the government prohibits Americans from obtaining health care necessary to preserve their lives, or limits their ability to obtain it, this health care rationing is a form of such involuntary euthanasia.