December 2, 2020
Should an “expert panel” be able to put a value on how much your life is worth? Well, it can and does—and that value can determine whether or not you get vital treatments to prolong or save your life. Though the policy is part of President-elect Joe Biden’s proposed healthcare reform proposal, it’s not too late for Americans to take notice—or for legislators to put a stop to it.
A new report out today from the Goldwater Institute lays out how this system could further infiltrate the U.S. healthcare system, limiting needed care for the most vulnerable. As Goldwater explains, under this system of rationing, government payers and insurance companies decide what treatments they’ll reimburse based on recommendations made by the nonprofit Institute for Clinical and Economic Review (ICER), which assesses the value of drug treatments and tests. But according to ICER’s analyses, less money should be spent on treating a person who is sick, disabled, or old, because their life is deemed to be worth less. Assigning such a value to a patient’s life—a value known as a quality-adjusted life year, or QALY—can make all the difference between whether a treatment is approved or denied for reimbursement.
President-elect Biden’s proposal would adopt the use of an “expert” review board to assess the value of prescription drug treatments modeled on ICER and foreign countries’ healthcare systems that use QALYs and similar metrics to ration care. In their new report, Goldwater Institute Visiting Fellow Dr. Rafael Fonseca and Director of Healthcare Policy Naomi Lopez outline how this system would keep many patients from getting the care they need. “In addition to the ethical dilemmas such a system creates, ICER’s method of putting a value on a patient’s life doesn’t take into account the worth of fast-moving medical innovation, consistently undervalues treatments, and results in delayed and inferior care,” Dr. Fonseca says. “The consequences of systematically overriding physicians’ recommendations—physicians who are at the bedside and are aware of all details of a unique case—and relying on distant recommendations, often outdated or inadequate treatments, from an ‘expert’ panel can be truly devastating to patients.”
This also has big implications for the health crisis of our time. “COVID-19 is a particularly dangerous threat for the elderly and those with preexisting health conditions, and under the ICER approach, those most vulnerable to the virus could very easily end up being denied for the emerging treatments they need to survive,” Lopez says.
The Goldwater Institute says there are actions federal and state lawmakers can take today to rein in this form of healthcare rationing. Lawmakers at both the federal and state levels should build upon and expand the important steps that have been taken in Congress as part of the Affordable Care Act (ACA) and in Oklahoma to limit the use of QALYs in coverage decisions for government health insurance programs.
The QALY value assessment that assigns lower monetary values for the life years of the disabled, ill, and aged is rigged to limit care to these populations. That is why lawmakers should oppose QALY-based value assessments to determine coverage and reimbursement decisions for government healthcare programs. “ Lopez says, “Putting an arbitrary value on someone’s life shouldn’t factor into whether or not they’ll receive the care they need, and limiting the use of these values in coverage decisions will move us closer to the goal of having more accountable healthcare that responds better to patients’ needs.”