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Harris Sherline: Deciding Who Lives and Who Dies, Part I
Quality Adjusted Life Score is the methodology used by the United Kingdom to determine whether an individual is eligible to receive treatment for an illness. The formula reduces the decision-making to a dollars-and-cents evaluation. In short, if it costs too much, the patient is denied care.
Fortunately, we have not yet reached the point where our own health care is decided purely on the basis of cost. Or have we?
As lawmakers and the public have debated health-care reform, claims and counterclaims by each side that the other is trying to scare the public into supporting their position have served only to confuse the issue. However, comments made by Robert Reich, Labor secretary under President Bill Clinton and now an economics adviser to President Barack Obama, are worth noting.
During an appearance at UC Berkeley in 2007, he said:
“Let me tell you a few things on health care. Look, we have the only health-care system in the world that is designed to avoid sick people. That’s true. And what I’m going to do is I am going to try to reorganize it to be more amenable to treating sick people, but that means you, particularly you young people, particularly you young healthy people, you are going to have to pay more.
“And by the way, we are going to have to, if you are very old, we’re not going to give you all that technology and all those drugs for the last couple of years of your life to keep you maybe going for another couple of months. It’s too expensive. So, we’re going to let you die.
“Also, I’m going to use the bargaining leverage of the federal government in terms of Medicare, Medicaid — we already have a lot of bargaining leverage — to force drug companies and insurance companies and medical suppliers to reduce their costs. What that means, less innovation, and that means less new products and less new drugs on the market, which means you are probably not going to live much longer than your parents. Thank you.”
Reich’s honesty is refreshing. However, since honesty and transparency are hardly hallmarks of the Obama administration and Congress, we are forced to read between the lines in an effort to determine their true intent for reforming the U.S. health-care system. Is it now the prevailing attitude that the government intends to let old people die because caring for them is too costly?
The Brits’ QALY system is used to make life and death decisions about which patients will receive care or medicines. The decision-making process is reduced to a formula for rationing health care based on age and the estimated costs of providing medical treatment and/or services, including prescription drugs. (Click here for more information).
David Lee, a General Electric health economist, explained QALY as “... quality adjusted life year, a year of life adjusted for its quality or its value. A year in perfect health is considered equal to 1.0 QALY. The value of a year in ill health would be discounted. For example, a year bedridden might have a value equal to 0.5 QALY. ... We try and evaluate benefits and costs. The way we measure that is a QALY, quality adjusted life year ….We try to figure out what the QALY for certain technologies are. Is the gain in QALYs to the gain in costs worth it? The UK has something like £30,000 per QALY. If the technology can deliver at less than that, they’ll pay for it; if it’s more than that, they won’t. ... What it’s telling technology developers is that if you’ve got a high cost with low medical benefit product, your chances of getting into market are lower. If you’re a cancer patient that stands to benefit from an additional three months of life that will cost the NHS (National Health Service) $70k, is it worth it or not?”
It places a monetary value on human life. Decisions are made based on life expectancy. If a particular treatment isn’t determined to be worth the cost, care is denied. The rationale is that, while these may be difficult decisions to make, they are necessary. The thinking is that there has to be some way to measure costs in order to keep them from getting completely out of control. On the surface, that may make sense — unless, of course, you’re the one who needs the treatment.
Once again, the admonition “be careful what you wish for” applies.
— Harris R. Sherline is a retired CPA and former chairman and CEO of Santa Ynez Valley Hospital who has lived in Santa Barbara County for more than 30 years. He stays active writing opinion columns and his blog, Opinionfest.com.
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» on 10.25.09 @ 05:04 AM
The subtitle, “The true intent behind health-care reform is rationing treatment based on cost” is utterly obvious, but the remainder of the opinion piece is like listening to Fox ‘News’.
The QALY calculation has been used for four decades in health care economics, long before the Obama administration. And, it is used every day by insurers to deny care, sometimes even rightfully. We need to acknowledge, in this era of direct to consumer advertising, vagaries of internet information, and vastly more expensive therapies compared to a few decades ago, that some therapies really are not worth the cost, either to me as a patient or to our society.
Again, Mr. Sherline, please stop getting all your talking points from conservative blogs. Your relentless efforts to recycle and promulgate negative spin against all things Obama only undermines your relevance and credibility. With all your experience and training, please let us know how you would decide what works and what doesn’t, and how it should be paid for? Awaiting ‘Part II’...
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» on 10.25.09 @ 06:48 AM
Mr. Sherline, a question more then a comment; does the British system and perhaps the proposed US healthcare reform “ration” the care or the communal resources to pay for the care? Do citizens within these systems who possess disposable income above and beyond their insurance coverage get shut out of using personal resources to obtain greater care? There are not enough transplantable Livers available to meet demand nor the latest cutting edge equipment and procedures for every patient but is not the base level standard of care available in the US greater than that of elsewhere? Is the issue one of access by all despite financial circumstance? A crux of American perception seems to be the notion that every patient should be entitled to the highest standard of care irrespective of cost which is as unsupportable as is the rationing you describe. Where’s the middle ground?
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» on 10.25.09 @ 07:12 AM
Oh, for goodness’’ sake! Here we go again, being paranoid about “rationing of care”! People, it’s natural. We have it already.
Any time there is an imbalance between supply and demand - of anything - there is a rationing mechanism. It happens with gasoline. It happens with drugs (legal and otherwise). It happens with health care (no insurance, often no medical care!). And no bleatings of well-intentioned (?) paranoids is going to repeal the law of supply and demand.
A good example is The Oregon Health Plan. It sets up a prioritized list of medical procedures that will be covered by their stae-provided Medicaid. It’s been around for years, and is an excellent illustration of how to decide how to spend limited funds. For more information, see http://www.oregon.gov/DHS/healthplan/priorlist/main.shtml.
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» on 10.25.09 @ 08:21 AM
“since honesty and transparency are hardly hallmarks of the Obama administration and Congress,”
pray tell, Mr. Sherline, where are those weapons of mass destruction in Iraq? Was the Bush administration any less honest or transparent?
It’s not a Democratic or Republican thing… remember the Gulf of Tonkin?
But the real knee slapper is… the American health care industry is the biggest nest of dishonesty and obscurity on the planet. I’ve gone through the deaths of both parents, and what a rotten, greeding, thieving bunch of swindlers. Denial of care and rationing of life?
In Mr. Sherline’s health care industry, killing old people is done to get money to pay guys like him and William W. McGuire, the ex-CEO of United Health Care, who made $125 million a year.
Guys like that belong breaking rocks, with a cellmate named spike doing live for violent homosexual sex crimes. And to criticize the UK National Health Service, lauded by people like Stephen Hawking for saving his life, in favor of the likes of swindlers like McGuire? Tells you what kind of ethics and morals Harris Sherline has. Or doesn’t.
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» on 10.25.09 @ 08:53 AM
You should remember that Bob Reich is only ONE of Obama’s advisors on health care. I get the impression that our President listens to a lot of advice, and then (whether it is sooner, or in this case, later) makes up his own mind.
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» on 10.25.09 @ 08:59 AM
Good grief! I thought you liberals were all about compassion! Where is the compassion in QALY? There is none! None at all! It reduces a person’s life to “dollars and cents”. Good God how abhorrent can you get! I guess when your philosophy is based on hedonism and what’s good for ME it make sense, then so does abortion. Not one of you callus numb nuts ever consider making our society wealthier so that we can actually ADD quality to an aging persons final year, huh? Nope, so inculcated in your dopy repressive socialist “redistribution” philosophy you can’t see that there may be a better way than the old “robbinghood” method. Really shameful. The left, its all about stealing from someone else.
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» on 10.25.09 @ 09:15 AM
It’s amazing how often opponents of health care reform talk about the British system, in which the government employs the doctors directly and determines how much is paid for what. It’s amazing because that is the opposite of what is being proposed in America, where the insurance companies will decide how much is paid for what and where the doctors will be privately employed.
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» on 10.25.09 @ 02:08 PM
Leave it to an50 to be the first on the crazy train. Having fun, dude?
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» on 10.25.09 @ 02:58 PM
Pretty self-serving.
Sherline came here from LA to take a golden parachute to sell the Valley Hospital into the Cottage Hospital empire.
He didn’t take the money and run. He took the money and stayed.
But he’s still whining about it.
“Who lives and who dies” is decided, as it’s always been, by God, nature, blind luck,
your genome and ancestors, what’s wrong with you, what kind of treatment you get
(if any effective treatment exists).
Public or private, domestic or foreign, types of health care are only partial players,
even in the best of times.
If Platinum private health plans were the keys to longevity and good health, then
Ted Kennedy, Pavarotti, Steve McQueen, Lou Gehrig would all still be alive.
As Sherline knows, right now private, for profit insurers have the same “death
panels” Sarah Palin worries about government getting involved with.
How much coverage do you really get? How many choices? For how long? With what
kind of technology?
People die every day either because they’re poor working stiffs, and don’t know any
better.
Because their small-town doctors don’t know what “state of the art” is for what’s wrong with them.
Because their for-profit insurers won’t pay for the “best” treatment, since it might eat into their bottom line.
Sherline reads the same stuff as the rest of us, where for-profit insurers pay big bonuses to their “quality control” folks to cull their sickest clients from the rolls, even if it means condemning patients to bankruptcy and death.
As the comfortable, well paid Voice of corporate health privilege, Sherline should give it a rest.
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» on 10.26.09 @ 08:58 AM
Other than the snide comments that candidness requires reading between the lines and his “astonishment” that there is a dollar amount put on a human life, I for once agree with Harris that not requiring the gov’t to pay for every possible medical procedure is okay.
Back in 1977 when I was in college a professor in economics pointed out exactly what different industries were using to value life. We’ve been putting a “dollar” value on life for time memorial. This feigned astonishment that we’re doing this now is so disingenuous that it’s sad.
The underlying, but never mentioned point, is that it’s only restricting what the government is paying for and not what the patient could get. It’s not refusing service, it’s saying you have to get it on your own. The gov’t is not restricting one from the procedure, just not paying for it.
Sounds rational to me.
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» on 10.26.09 @ 09:40 AM
Sorry noleta hasn’t got a clue but then there is Publius attacking the messenger rather than the message.
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» on 10.27.09 @ 12:43 AM
Nice story on CNN today about how the medical insurance industry cancels policies to women who are raped. Gotta keep paying those $125 million/year salaries to the top executives like Harris Sherline and William McGuire, so any excuse must be used to cancel coverage after collecting years of premiums from the little people! And of course those scoundrels will argue against any government oversight that might, say, keep rape victims from having their insurance canceled by the wonderful generous insurance industry. Harris Sherline feels they just *deserve* their $125 million/year, and that rape victims were asking for it.
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