Friday, April 20 , 2018, 11:55 am | Fair 62º


Harris Sherline: Deciding Who Lives and Who Dies, Part I

The true intent behind health-care reform is rationing treatment based on cost

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.

Harris Sherline
Harris Sherline

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,

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