As the novel coronavirus spread throughout the United States, we witnessed incredible acts of selflessness. Healthy young adults, who were at little risk of dying from the virus, sacrificed by staying away from schools and workplaces.
The goal was to help protect older, more vulnerable Americans, and also to keep our healthcare system from being overwhelmed by people suddenly needing care. Notice that Americans specifically rejected a “quality of life” argument: the idea that public policy should value healthier people more than ailing ones. One man who proposed such an idea was widely mocked on social media.
So why does the House of Representatives want to sneak Quality-Adjusted-Life-Year (QALY) considerations into American health care?
The Partnership to Improve Patient Care explains how QALY works: “The QALY methodology assumes that a year spent in certain states (such as perfect health, represented by 1.0) is more desirable than a year spent in other states (such as paraplegia, ranked by some QALY systems at approximately 0.5, implying that the lives of people with paraplegia are worth approximately half the lives of individuals without).”
The organization rightly opposes using QALY as a way to determine who gets what medicines. It would, after all, be discriminatory to deny a crucial drug to a patient just because that patient has a chronic condition that “reduces” her “quality of life.” Who are we to judge?
However, lawmakers don’t want us to look at things that way. They say the issue is about controlling the cost of prescription drugs. H.R. 3, now called the “Elijah E. Cummings Lower Drug Costs Now Act,” claims the goal is to “establish a fair price negotiation program” for drugs. The bill has passed in the House of Representatives.
But what the bill would really do is impose price controls, and those controls would be set by groups of experts. You can fairly call them “death panels,” because if these experts deny a drug to a critical patient, that patient is going to die. That already happens in European countries, where socialized medicine means the government sets artificially low prices for drugs, and so companies either don’t develop new treatments or won’t sell them for the asking price.
Here in the U.S., H.R. 3 proposes to target medicines that do not have competitors. However, imposing price controls on any first-in-class drug creates exactly the wrong incentive for drug companies. Why invest huge amounts in a treatment that the government may not be willing to pay for? Instead of investing in the development of new treatments for our most devastating conditions such as Alzheimer’s or Parkinson’s, drug companies might focus on treating acne. Or simply not develop any new medicines at all.
As advocates for the disabled have noted, H.R. 3 would create the opportunity for the government to make value assessments that would discriminate against our most vulnerable populations. For example, existing value assessments assume that a year spent in perfect health, is worth “more” than a year spent disabled, ailing or, heaven forbid, elderly. This method for value assessment completely disregards the fact that someone living with a chronic condition or disability may be just as satisfied with their life as someone in perfect health.
Lawmakers realize all this, of course. “The Secretary shall not utilize such an adjusted life year (or such a similar measure) as a threshold to determine coverage, reimbursement, or incentive programs,” Congress wrote into federal law.
But, again, under a socialized medical approach, the only way for the government to reduce costs is to ration care. That means panels of experts will be making life — and death — decisions for Americans. Death panels, all in the name of supposedly making drugs more affordable.
Innovation makes the American health care system the envy of the world. QALY considerations would replace creativity with quotas and lead to avoidable deaths. Americans simply cannot afford H.R. 3.