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.