QALY (Quality Adjusted Life Score) is the methodology used by the United Kingdom (UK) to determine whether or not 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 legislators and the public have debated healthcare reform, claims and counterclaims by each side that the other is trying to scare the public into supporting their position have only served to confuse the issue.

However, comments made by Robert Reich, former Labor Secretary in the Clinton administration, now an Obama economics advisor, are worth noting.

While campaigning for the Democratic presidential nomination at the UC Berkeley campus in 2007, he said: “I’m so glad to see you, and I would like to be president. Let me tell you a few things on healthcare. Look, we have the only healthcare 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 is 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.”

Secretary 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 to determine their true intent for reforming America’s healthcare 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 (see


David Lee, a GE 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 QALY 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?”

This 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.


© 2009 Harris R. Sherline, All Rights Reserved

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