"If we ration we won’t be writing blank checks to pharmaceutical companies for their patented drugs, nor paying for whatever procedures doctors choose to recommend.
"When public funds subsidize health care or provide it directly, it is crazy not to try to get value for money.
"The debate over health care reform in the United States should start from the premise that some form of health care rationing is both inescapable and desirable. Then we can ask, What is the best way to do it?
". . . the quality-adjusted life-year, or QALY, [is] a unit designed to enable us to compare the benefits achieved by different forms of health care. The QALY has been used by economists working in health care for more than 30 years to compare the cost-effectiveness of a wide variety of medical procedures and, in some countries, as part of the process of deciding which medical treatments will be paid for with public money. If a reformed U.S. health care system explicitly accepted rationing, as I have argued it should, QALYs could play a similar role in the U.S.
"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?" ---from "Why we must ration healthcare" by Princeton ethicist Peter Singer
The Undercover Economist: exposing why the rich are rich, the poor are poor--and why you can never buy a decent used car!
by Tim Hartford (2005)
[page 126] An intriguing case in point is Britain's National Health Service (NHS), which offers health care to all citizens. It is almost completely free, although people with jobs need to pay a token amount for prescription drugs. It provides universal coverage: if you walk into any doctor's surgery or any hospital in the country, you will be treated free of charge.
[page 127] As you would expect, the system gets overcrowded, people often have to wait, and patient choice is not a major feature of the system: you accept whatever treatment the doctor says is appropriate, or nothing. Overall, the medical outcomes are not bad, but the waiting lines for treatment have been a major bone of contention for many years. . . .
If you were going blind in Britain, you would be well aware of a recent example
of the difficulties faced by such a system . . .In 2002 NICE filed a report recommending photodynamic therapy only in more extreme cases, only when both eyes are affected, and only in the eye that is less seriously damaged. The implication is that even treated patients will lose their sight in one eye, while others whose sight might be improved are denied treatment altogether.[page 128. NICE calculates]the impact of each treatment in "Quality-Adjusted Life Years" , or QUALYs. [these value judgments] must be made in a system that provides health care free of charge.
[page 129] The dispassionate perspective of QUALY analysis argues that the difference between having two good eyes and one good eye is less significant than the difference between having one good eye and none at all. Small wonder that the calculations then to churn out embarrassing recommendations. But a free service will always be in demand, and it is hard to see a better way of rationing it.
If you think health care is expensive now,
wait until you see what it costs when it's free.
-- The Liberty Manifesto by P. J. O'Rourke (1993)
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