What’s the value of a human life? It’s a most provocative question.
In socialized healthcare systems globally, that question is at the center of every decision public officials make: how much money to spend on care, whether to approve an innovative new drug or medical device for use, who gets timely access to treatment, and who has to wait, and so forth.
These kinds of questions are starting to make their way into the United States.
The Institute for Clinical and Economic Review, (ICER) a Boston-based nonprofit, estimates how many additional quality-adjusted years of life, or QALYs, a given medical treatment can deliver — and then compares that figure with the therapy’s price to determine whether it’s cost-effective.
Many progressives have embraced ICER’s approach as part of their drive to put the government in charge of an ever-greater share of our healthcare.
Thankfully, several House Republicans want to put an end to all that. This week, Reps. Jim Banks, R-Ind., Cathy McMorris Rodgers, R-Wash., and Brad Wenstrup, R-Ohio, introduced the Protecting Health Care for All Patients Act, which would ban the use of QALYs in federal healthcare programs.
Aside from being profoundly dehumanizing, QALY calculations undervalue the lives of the chronically ill and disabled. They have no place in America’s healthcare system.
Foreign governments have used QALY analyses for years as justification for denying needed care to patients.
The premise behind these calculations is that one QALY — that is, a single year of human life — is worth a specific amount of money based on the age and predicted health of the patient.
For instance, it’s estimated that Canada’s single-payer system values a year of life in perfect health at around $50,000 Canadian. In U.S. dollars, that’s a bit less than $40,000.
So, if a new drug can extend someone’s life at full health but costs more than $50,000 a year, the QALY calculation would recommend against Canada’s government-run, single-payer system paying for the medicine — even if that drug were a person’s only hope of survival.
These brutal calculations help explain why people in other countries often lack access to the most sophisticated drugs and treatments, especially compared to patients in the United States.
Of the 98 new cancer drugs released between 2011 and 2019, 96% were available to Americans. U.K. patients, on the other hand, had access to just 70% of these drugs. In Canada, only 59% were on offer. In Japan, that figure was just 58%.
For governments in these countries, saving human lives is only worthwhile at a certain price. And if a cancer medicine — or heart drug or multiple sclerosis therapy — costs too much, they won’t pay for it, no matter how much suffering that decision causes.
QALYs also minimize the value of sick and disabled people. Under most frameworks, officials assign weights between zero and one to particular health statuses, from mobility to mental health.
Zero is equivalent to death; one is equivalent to full health.
According to the Disability Rights Education and Defense Fund, “People with certain disabilities receive a QALY score of less than 0, suggesting that life in such a health state is considered worse than death.”
As the Fund wryly notes, “Unsurprisingly, individuals in such health states frequently disagree with this assessment.”
Discrimination against vulnerable populations, in other words, is built into the very logic of QALY analyses.
This kind of prejudiced reasoning isn’t an ancillary feature of socialized healthcare systems — it’s a basic requirement. If the government is in charge of paying for medical care, then public officials will need some way of determining whose life is worth saving and at what cost. QALY analyses are often the method of choice.
The threats posed by QALYs might seem abstract and distant. But they’re actually more urgent than ever. Many of the most prominent healthcare proposals advanced by Democrats — including Medicare for All and price controls on prescription drugs — necessitate QALY analyses, or something like them.
It’s time to stand up against this blatantly discriminatory practice, before it’s too late.