How Much Is a Year of Your Life Worth?

If they know what’s good for them, older folks will be especially attentive to one undercurrent in our present health care debates: an increasingly widespread view that the allocation of medical treatments—and indeed, the worthiness of human life—should be subject to a cost-benefit analysis.

Obama’s stimulus plan, for example, includes substantial funding for what’s called “comparative effectiveness research,” to test various treatments for the same illnesses and report their findings to the president and Congress, which will presumably use it in their policymaking decisions. As the New York Times reports, “Supporters of the research hope it will eventually save money by discouraging the use of costly, ineffective treatments.”

On one level, this is only sensible. And thusfar, the main opponents of comparative effectiveness research seem to be conservatives, who fear any kind of government intervention into the current–and highly unequal–private system of health care dispensation. But what worries me about this approach is how the data it acquires might be used—or misused. 

On its Economix blog, the Times has been running a series of posts by Princeton economics professor Uwe E. Reinhardt, the latest of which discusses the concept of “QALYs”–“quality adjusted life-years”—which could be used to help determine how the government spends its health care dollars. 

QALYs are a metric widely used now in cost-effectiveness research. They are meant to adjust for the fact that not all years added to people’s lives are equal. A medical intervention yielding a given number of additional life-years in perfect health makes a greater contribution to human well-being than an intervention that yields the same number of life-years in less-than-perfect health. QALYs are used to adjust for that difference in a patient’s quality of life. 

Who, I wonder, is going to determine the quality of our life-years—especially as we get older? I’m 72, and I know it’s been a long time since I had a year in “perfect health.” It seems to me a very short leap from calculating QALYs to instituting age-based health care rationing, an increasingly popular proposition under which the elderly are told they should sacrifice some of their “less than perfect” life-years for the good of all by forgoing costly medical treatments.

As I’ve written before, arguments for age-based health care rationing are in turn based upon the idea that if we don’t do something like this, health care costs—and especially Medicare—will soon bankrupt what’s left of the American economy. But this idea rests upon a major fallacy:  that there’s nothing else we can do to lower costs other than withhold care from the greedy geezers who want a new hip or a heart bypass when they haven’t got long to live, anyway.

In fact, there are plenty of other things we can do to cut costs—for a start, kicking the insurance companies out of the mix, reining in the drug companies, and instituting a single-payer system, which could lower our national health care  bill by as much as 40 percent while providing improved care to Americans of all ages. This fact is supported by numerous studies comparing health care in the United States and other industrialized countries, conducted by the World Health Organization, Congressional Research Service, Kaiser Family Foundation, and Commonwealth Fund, among others. 

So I’ll say it again: As a public-spirited old person, I might be willing to give up some costly, life-sustaining treatment if the future of humanity depended upon it. But I’m not going to sacrifice a single life-minute to preserve our system of medicine for profit.

5 responses to “How Much Is a Year of Your Life Worth?

  1. “kicking the insurance companies out of the mix, reining in the drug companies, and instituting a single-payer system”

    There you go, the condensed version of the best solution.
    Well said.

  2. Dick Mulliken

    I’d prefer a nationalized health system to single payer. My hospital,has all it’s staff (including my doc)on salary (private practice prohibited). Management, including interspecialty collaboration is superb. Staff morale at all levels is excellent. What is this but small scale nationalization? I can dream.

  3. you know…Social Security, got raided back in 1978…again really hard in 1985, and now it is just ‘normal’. I still think, when you consider the huge wealth that is thrown into the Social Security ‘fund’ that IF the ‘fund’ wasn’t consistently raided..hehehee (think black box) ….Social Security would be sound. Oh yeah and that lie that has been circulating for the last 30+ years, —it never was about women with 5 kids driving a caddy! The actual theives are in D.C. hahahhaaaaaa

    wild;)

  4. Marilyn Howells

    Something new and very, very scary !! I wonder if anyone has ever hear of this or had it happen to them. My employment related insurance that covers actives and retirees, now is proposing that we have to provide End of Care Directives (Advance Directive) or pay higher premiums than those that do provide this, WHEN MANY WOULD ONLY WANT THIS FORM IN THE HANDS OF THEIR FAMILY OR THE PERSON WHO THEY DESIGNATE AS MEDICAL POWER OF ATTORNEY. This should and may be unconstitutional. While I don’t disagree with someone’s right to have and End of Care Directive, I’m outraged that the insurance company wants to financially coerce us into providing the paper to them or some third party registry. What are the chances one of the forms will get enacted before the family even gets there if you are in an accident? What are the chances one John Smith’s forms will be mixed up with another John Smith’s form? Or some of the middle pages will get switched with someone else’s middle pages. After all none of us have ever be mixed up with someone else, received a bill or piece of mail that is wrong etc. Of course there will be mix ups. However, if you die because of it, you won’t be around to straighten it out. Then what will happen over the years. will the insurance companies dictate the wording on these directives, raise your premium even more if you don’t sign one, withhold services if you don’t sign, or drop your insurance if you don’t sign.Or maybe eventually, they won’t pay for certain services if you don’t sign one. But if they know you have a directive or even the content, will services you might want be withheld, or withheld prematurely. Eventually, will this lead to insurance companies to put pressure on you physicians and family, or on your family through the pressure the insurance company puts on the physicians. Will the insurance company or some supposed mediator or adviser presume to interpret the living will? They already withhold antibiotics on the very sick sometimes. What if you have a slow cancer, like prostate and are only in for tests and could like for years on lupron, and choke on you dinner steak? Will you not be resuscitated because technically you are terminal. How can we trust insurance companies in this. End of Care / Do Not Resuscitate Directives are very serious and every word is open to interpretation. It should NOT be the insurance company where CEO’s make up to 124 million based on company profits, who interpret these living wills, or their flunkies or any third party entities they choose. These should only be interpreted by the family in conjunction with your physicians. Once the precedent is set the even one insurance company require proof of a living will and it affects your payment, then how long until others follow suit???? Obviously, if this gets started other insurance companies will jump on the band wagon, and a lot of people will be mislead into signing dangerous broilerplate directives, that don’t protect them adequately and are wide open to interpretation, and could be misused, and more poorly worded than you would think. If we don’t stop the insurance companies now, it will be to late later. As far as I know neither Medicare, Medicaid, VA, Federal Employees Insurance, nor any private insurance of anyone I’ve asked requires this or ties it to premiums. The whole idea makes one think of 1984 (by James Orwell), Make Room, Make Room (by Harry Harrison, think Soylent Greeen the movie), or Logan’s Run. Anyone doing an Advance Directive would want to be real careful into whose hands they put it and when. I doubt if they can legally force you to make on, or if you have one force you to hand it over to get care. some feel that this should only be trusted to a group of several relatives to decide when to hand it over. Many feel it’s best to have it give someone medical power of attorney to interpret your wishes, so some bean counter won’t. You certainly want your relatives to have time to find and consult with specialist and physicians of your and their choosing.After all no one ever went to several doctors over several months or years until they finally got the right diagnosis or treatment. Anyway this gives new meaning to the phrase BURY IN HASTE, REPENT AT LEISURE. They may be planning to have us store our End of Care/Advance Care Directive at a Central Repository. One national one out in California does not require Social Security Numbers, but they are optional as someone people object to giving it out. After someone sends them their living will, they are sent a special identification card with an assigned number that a physician can use to call the company and have the Advance Directive Faxed or emailed. But if the person doesn’t have the card, the hospital can order it by name and SSN, or if the person didn’t give the repository their SSN, the hospital can get it by just giving the patient’s name and birth date. How long until one John Smith is mixed with another. How many people in this country have the same name name as someone else, and maybe even are about the same age. Google your name and also run it on yahoo people search,, and don’t forget to use alternate spellings (especially of your first name), and nick names. Think you won’t be affected because your insurance company doesn’t require this? Think again. You never filed an End of Care Directive with a repository. You’re in an accident and are taken unconscious to a hospital, which calls a few repositories with you name and birth date, and a match is found, faxed, and used to withhold care. But it was only the directive of someone with the same name.Too late, R.I.P. Please post on this site if you’ve ever heard of an insurance company requiring you to Provide an End of Care Directive or pay a higher premium if you don’t. Also if you know of any web sites about the dangers of misuse of Advance Directives/Living Wills, or problems with interpretation of these documents, and tips on wording them please post those site. Below I’m listing a couple of sites found in a quick search with some 2006 Federal law, and concerns about wording of this type of document, or misuse. While one might not support every word at sites they provide a lot of helpful information, concerns, and example.
    For tips on writing living Wills and Advance directives, and pros and cons of language.
    http://www.internationaltaskforce.org/rpt2006_2.htm#212
    Before You Sign On The Dotted Line
    http://mysite.verizon.net/cureltd/id24.html
    Federal law about Advance Directives that prohibits requiring one as a condition of treatment. See Advance Directives, 42 CFR 489.102 (a) (3) (2006).
    http://law.justia.com/us/cfr/title42/42-3.0.1.5.27.8.206.2.html
    You might want to read or skim it all, but it reads in part:
    489.102 Requirements for providers (a) Hospitals, critical access hospitals, skilled nursing facilities, nursing facilities, home health agencies, providers of home health care (and for Medicaid purposes, providers of personal care services), hospices, and religious nonmedical health care institutions must maintain written policies and procedures concerning advance directives with respect to all adult individuals receiving medical care, or patient care in the case of a patient in a religious nonmedical health care institution, by or through the provider and are required to: . . . (3) Not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive

  5. Pingback: Time for Hell’s Grannies to Ride Again « Unsilent Generation

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