QALY QALY Oxen Free!

posted at 10:55 am on July 30, 2009 by King Banaian

First, thanks to Ed for the invitation to the Greenroom.  It’s an honor to be here.

Over the last few days I’ve been posting on the use of QALY, the “quality-adjusted-life-year”.  Rather than repost that entire dialog, which is quite long, let me summarize it here with links back to my blog if you want all the details.

At the end of my radio show (which follows Ed on Saturdays at AM 1280 in Minneapolis) I had challenged listeners to learn more about QALY.  It is used by health care administrators and researchers to measure the benefit of a given medical procedure.  The goal is to provide them with a common denominator in measuring benefits — how many years of life is expected to be gained in a patient if we give him this treatment?  But the QA part says not all years are equal, nor is an additional year of life in a healthy 25-year-old male equivalent to that of a 55-year-old parapalegic female.  You have to adjust for quality.

David Catron noted last week that in Britain in 1993, its “National Institute for Health and Clinical Excellence” or NICE had determined that it could not spend more than $22,000 for a procedure that added 0.5 QALYs (that probably comes to about US$32,750 today.)  As I explored that thought, what bothered me was that the decider of whose benefits and whose costs was the governments.  To get economic decision-making right, the person who takes the benefits and pays the costs is the best positioned to make the right decision given they have good information.  I wrote:

When anyone else makes the decision — let it be a neighbor, your rabbi, or a committee; it need not carry the name ‘government’ — they lack the knowledge needed to solve the problem. “If we can agree that the economic problem of society is mainly one of rapid adaptation to changes in the particular circumstances of time and place,” wrote Friedrich Hayek in The Use of Knowledge in Society, “it would seem to follow that the ultimate decisions must be left to the people who are familiar with these circumstances, who know directly of the relevant changes and of the resources immediately available to meet them.” That’s unlikely to be anybody sitting in Washington DC, when it comes to the care of my family in Minnesota.

So for example we’re told that half of medical costs come in the last year of life.  But do we know when our last year of life is?  Often not.  My uncle was told he had Lou Gehrig’s disease and six months to one year to live; he made it seven years because he figured if he walked five miles a day his muscles wouldn’t have time to atrophy.  When he stopped walking to grieve his mother’s death, the disease caught up.  “Who knows when death may overtake me,” the hymn goes.  Will the QALY cop know or care that my genetics are good (three grandparents live well into their 90s), or I’m from Minnesota where longevity is excellent and health care costs lower?  Will they find out I smoke two cigars a day?  And so what if they do?

The QALY calculus says there are two kinds of procedures: those for which the benefits exceed the cost, and those for whom the benefits fall short.  But in fact there are many procedures where the benefits are probabilistic; treatment is neither necessary nor unnecessary.  I explored the procedure of routine colonoscopies today, thinking about the decision and wait times in various countries, and the correlation to mortality rates from colon cancer.  The important point is that QALY won’t save us money.  In fact, it probably makes matters worse.

[W]hat does it mean to use a QALY calculation for a treatment that is neither necessary nor unnecessary? The political economy of that is difficult. No politician will want to be seen as funding some unnecessary procedures — that supposedly is why they want to have health care reform. But if colon cancer mortality rates start to reach British or European levels, those who pass Obamacare will not see power again for a very long time. Knowing that, they are likely instead to keep funding many of those middle-category procedures, just as they do now. Electoral outcomes are part of the cost-benefit analysis when government chooses your medical procedures.

I’ll continue this series the rest of the week, to try to answer the question that conservatives really do need to answer — if you don’t like the proposed Democrat reforms, what would you do instead?  It is best to be proactive in this regard, since if you’re not you will be said to support the current system with all its warts.  It undoubtedly has them.

This post was promoted from GreenRoom to HotAir.com.
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If it’s my years, then I’m likely to place a high value on my QALY. If it’s somebody else’s years, then it’s not worth nearly as much.

hawksruleva on July 30, 2009 at 11:00 AM

Here you go: The abortion procedure leaves a child with 0 QALY. Therefore it is fiscally irresponsible to fund abortions at any price.

Daggett on July 30, 2009 at 11:00 AM

I’m sorry, your QALY Charts says…

mjbrooks3 on July 30, 2009 at 11:03 AM

Those government healthcare clerks are going to get overwhelmed in trying to cross reference all these charts to see if we qualify for care.

Better just to predicate the decision on union membership and racial characteristics.

Bishop on July 30, 2009 at 11:06 AM

QALY? How long before that morphs into GSLRP (Government Savings & Life Reduction Program)?

darwin on July 30, 2009 at 11:08 AM

So why doesn’t 60 minutes spend 20 talking about this? Oh yeah. Never mind.

Ordinary1 on July 30, 2009 at 11:09 AM

AARP. Soon to be the nation’s leading supplier of Soilent Green.

Ordinary1 on July 30, 2009 at 11:10 AM

This topic in taken on at Kevin MD today, as part of a series of original guest columns by the American College of physicians. (The guest author today is Steven Weinberger, MD, FACP).

It is the same concept, however framed “delicately”, avoiding statist anacronyms in favor of apparent rationality…”just asking questions”. I suggest you read it. For it is preparation for a push for callous statist algorithms to contain cost, at sacrifice of what American law has formerly regarded as the purview of an individual in charge of his own life and pocketbook.

SarahW on July 30, 2009 at 11:12 AM

It’s great to have you posting at HA, King. I listen to your show on Saturdays via the internet and always enjoy your rational analysis of economic matters.

Cheers

Cody1991 on July 30, 2009 at 11:14 AM

I say we do a QALY on this administration.

moonsbreath on July 30, 2009 at 11:15 AM

Electoral outcomes are part of the cost-benefit analysis when government chooses your medical procedures.

Yep, when it comes to research the popular diseases with ribbons and wristbands and a galaxy of Hollywood stars will skew what gets funded everytime. Some really big star is just going have to get colon cancer before it is a cool affliction.

highhopes on July 30, 2009 at 11:23 AM

Brings to mind an old episode of Law & Order: Woman has her sister killed … story line winds out … when she’s caught, McCoy says something about her not having the right to take her sister’s life, and she says “My sister was a clerk in Iowa; my sister didn’t have a life.” (may have missed the state there).

Anyway, will QALY now be an affirmative defense to murder???

MochaLite on July 30, 2009 at 11:23 AM

Let me see if I understand.

I can buy surgery and live-preserving medical care for my elderly dog, but not for my grandmother.

Is that about the size of it?

Hey senior-suckers citizens, do you grasp the sheer evil of this fact?

Thanks AARP!

jeff_from_mpls on July 30, 2009 at 11:25 AM

Of course being a “caring Dem” is worth +10 points, and being an “evil Repub” is -1000…

RalphyBoy on July 30, 2009 at 11:25 AM

Isn’t this the abortion argument in the raw? They won’t have a good quality of life…will probably live in the South and just be a fat angry white male. Therefore…since their quality of life will be less than that of say…a democrat…they shouldn’t really have the “right” to exist.

lm10001 on July 30, 2009 at 11:27 AM

Die Bundesregierung ist Ihr Operateur.

Johan Klaus on July 30, 2009 at 11:28 AM

“He has blinded their eyes
and deadened their hearts,
so they can neither see with their eyes,
nor understand with their hearts,
nor turn—and I would heal them.” – John 12:40

kirkill on July 30, 2009 at 11:29 AM

Figures that group would be called NICE. Wasn’t that the name of the technocrat group in Lewis’s That Hideous Strength?

Pianobuff on July 30, 2009 at 11:33 AM

I often imagined what 1930′s Germany was like… this might be too close for comfort.

mjbrooks3 on July 30, 2009 at 11:34 AM

King,

My basic philosophy, as far as this question goes, is that government is the worst way to do things, and that all decisions should be made at the lowest level possible. With that in mind, what would I do instead?

Incentivize preventative care. This can be done through a simple tax deduction that should more than cover the cost of a basic physical, say, $250/yr. This has the ‘wart’ of requiring all doctors to file a list of the social security numbers they’ve given a basic physical to in a given year… but that’s a relatively simple fix to medical billing.

Want a nice liberal-esque sob story? This simple change would have saved by brother-in-law’s life – he died of a cancer that should have been caught during a routine physical, but .. because he didn’t take the time off work to get checked out… he’s left behind three children in school and my sister and rather limited resources.

Dis-incentivize insurance-as-carte-blanche by disassociating insurance from employment and “letting the market balance it”. Candidate McCain’s proposal to tax health insurance and allow a $5000 credit is a good start in that direction.

Right now, the market for health insurance is not Joe and Jane Sixpack, it’s the company they work for – it’s re-sold by Human Resources as a benefit of employment. This distorts the marketplace, and makes it look, to Joe and Jane, like it’s some kind of right, instead of – like auto insurance – something that they can help reduce the cost of through their own actions.

Finally, tort reform. A huge part of medical cost is insuring doctors, nurses, hospitals, etc. against mistakes. Ironically, this requires doctors, nurses, hospitals, etc. to work longer hours for less profit.. increasing the chances for mistakes to happen.

Simply capping “punitive damages” at a set amount seems overly simplistic, so might be better as far as getting a deal passed. I’d rather see something that incentivizes better behaviour. Some states do something to drivers where they put a “point” on the license, and they come off the license after a certain time has passed. Why not put points on a given doctor or nurse or hospitals’ license – they all have licenses, even hairdressers have licenses – and after a certain number of “points”, require the person or institution to go through some form of remedial tune-up, perhaps a re-training in basics, perhaps an audit by a blue-ribbon panel from a related profession – for a hospital maybe administrators from 10 other area hospitals review procedures…

Mew

acat on July 30, 2009 at 11:36 AM

This galls me especially because King Hussein of the USA just looted our treasury of a trillion dollars for a frivolous and failed stimulus, and is now hiding behind fiscal responsibility rhetoric to deny medical treatment to senior citizens.

I don’t want to be extreme here, but does it seem to anyone else that the cost savings were never really the objective of “health care reform”? It seems to me the elimination of the sick and the weak among is the point; the economic argument is half-hearted and pro-forma, maybe even intended to ease the consciences of these animals we put in power.

This is sickening.

jeff_from_mpls on July 30, 2009 at 11:37 AM

I know this is a dark side that people would not like to address, but when bureaucrats start denying treatment to people, distraught people with guns will start looking for them.

Blake on July 30, 2009 at 11:38 AM

I know this is a dark side that people would not like to address, but when bureaucrats start denying treatment to people, distraught people with guns will start looking for them.

Blake on July 30, 2009 at 11:38 AM

No doubt. Nothing could be more infuriating than a fat, corrupt bureaucrat telling you you have to suffer and die.

Of course the same fat, corrupt bureaucrats will be under a totally different, and private health care system.

darwin on July 30, 2009 at 11:42 AM

Comrades, it is the duty of every American to die for his country if he costs the state too much to maintain.

To think otherwise is to plot treason against the very foundations of this great country which so many have shed blood and died for.

Think of the life, liberty, and pursuit of happiness government services you will deprive of your family, friends, and fellow countrymen.

Do not live in shame !!!

Do your patriotic duty today !!!

elgeneralisimo on July 30, 2009 at 11:43 AM

Isn’t this the abortion argument in the raw? They won’t have a good quality of life…will probably live in the South and just be a fat angry white male. Therefore…since their quality of life will be less than that of say…a democrat…they shouldn’t really have the “right” to exist.

lm10001 on July 30, 2009 at 11:27 AM

That’s it exactly. And should you have a child with a severe birth defect, well then, the best thing you can do fore everyone involved is kill it. Why should the poor thing suffer and why should you have to put up with all the expense and hassle of years of treatment? Just so they can live an imperfect life? How selfish of you.

Sorry but I have two great kids who would be DEAD under this scenario and I have no patience WHATSOEVER with this.

Lily on July 30, 2009 at 11:43 AM

lm10001 on July 30, 2009 at 11:27 AM

No.

SarahW on July 30, 2009 at 11:44 AM

Lily, wrong.

SarahW on July 30, 2009 at 11:44 AM

I don’t want to be extreme here, but does it seem to anyone else that the cost savings were never really the objective of “health care reform”? It seems to me the elimination of the sick and the weak among is the point; the economic argument is half-hearted and pro-forma, maybe even intended to ease the consciences of these animals we put in power.

This is sickening.

jeff_from_mpls on July 30, 2009 at 11:37 AM

I never understood the cost savings either. Especially since the 40 or 47 million uninsured figure is bogus. I realized that they are worried about medicare and the boomers. However, the feds are the one who mismanaged medicare. It’s a boom area for fraud and crooks. With national healthcare, the opportunities are endless. The government is worried about what they have to pay — not what those of us who are insured are paying.

Another motive is that the elite want us to be euroweenies, which includes killing the sick and disabled.

Blake on July 30, 2009 at 11:45 AM

Lily, wrong.

SarahW on July 30, 2009 at 11:44 AM

Expand

darwin on July 30, 2009 at 11:47 AM

Then there is the concept of payment into a system per net year that is now driven downwards by SSN. Consider that when SSN was passed the retirement age was at or just a bit above average life expectency, meaning that your input of work years consisted of 45% of your life (subtracting out time as a child and teen, and then the year or so after ‘retirement’). By fixing the age of retirement and seeing the historical demographic increase in life expectency (which was known at the time) you add a delta of years in of generally non-working, non-contributing time. That delta in life expectency now puts individuals in the position of working 31% of their life to pay into any such system.

Changes in retirement age have come nowhere near to tracking the life expectency rise (1 year per every 4) for both men and women. Thus when you get to the final ‘highest paying medical year’ you are also at the year in which any system you have paid into has been supporting you in a non-financially supportable position. As the number of those in old age increase compared to those in their prime productive years, that ratio change makes the elderly, who should have been investing in themselves for a retirement, have fewer individuals to support their years between retirement and the last high paying year.

That financial shift via demographics is unsupportable, which is why SSN is now racing towards insolvency with an economy gone sluggish and a government heading towards insolvency. That insolvency date has been pushed ever back from 2050 to 2030 to 2020 to 2014 and now a few are prognosticating less than that…

Your grandparents and great-grandparents did not pay out that much, had no expectation of having it all paid for by government and understood that charitable hospitals and institutions would help their family at the end of their lives… and they would end up living with their children and grandchildren which was an acceptable option for families: to choose the most stable family amongst the children for aged parents to move in with.

America now puts the most productive people on the planet on golf courses and pays them not to work… and as the late 50′s and early 60′s are now becoming ‘Middle Age’ this points to a horrific problem if we keep such backwards views about what to expect from life that we have today.

ajacksonian on July 30, 2009 at 11:47 AM

I often imagined what 1930’s Germany was like… this might be too close for comfort.

mjbrooks3 on July 30, 2009 at 11:34 AM

Not until Obama starts the outright theft of private property from certain political demographic classes to reward his loyalists. What’s scary is that taxing the rich is just nibbling at the edges of the wholesale wealth redistribution that is at the heart of this rat bastard traitor’s agenda. 1930s Germany could well be a reality in the US under the dictator who currently holds power.

highhopes on July 30, 2009 at 11:48 AM

Thanks, kbanaian! This is the stuff we all need to know.

Hey senior-suckers citizens, do you grasp the sheer evil of this fact?

Thanks AARP!

jeff_from_mpls on July 30, 2009 at 11:25 AM

“Evil” is a word I seldom use. But ObamaCare is EVIL. If ever there was evil, this is it.

petefrt on July 30, 2009 at 11:49 AM

SarahW on July 30, 2009 at 11:44 AM

When you comment here as if you are texting or on twitter, no one understands what the hell you are trying to say. Make an effort to communicate like an adult or don’t waste your time.

Blake on July 30, 2009 at 11:50 AM

I can’t think about this. I honestly can’t stomach reading any more about this.

Can anybody name a single Utopia that ever turned out well?

The fact is, Utopian planning is the mark of a declining civilization.

Hannah Arendt had a famous analysis of Adolph Eichman’s war crime trial, in which she noted that the bureaucrats were simple, unthoughtful people. They would talk in detail about the technical efficiency of the socialist programs, even with a certain smug pride. It was there that she coined the famous phrase the banality of evil.

Does it not chill anyone else to the bone that there is not a single moral argument coming from this mob? Not a single ideal of what constitutes a good society. There is no wisdom, and no reflection. They are throwing numbers at us, and mind-numbing details.

Our goddammed uneducated culture lops it up like dogs. Except actual dogs will get better health care than the imbeciles who are support this evil, evil program.

jeff_from_mpls on July 30, 2009 at 11:52 AM

SarahW

I certainly hope you never have to sit there while doctors and nurses tell you that your child will “probably never have a normal life” and the best thing to do for him would be to “let him pass. Once we take the life support off he will be gone in minutes.” And then as an afterthought, “Or we could do this short 2 hour surgery and maybe he will live.” 14 years ago, parents had the right to opt for surgery. With QUAL, they won’t.

Most parents who are told before birth that their child has a diaphragmatic hernia are advised to have “medical terminations”.

Lily on July 30, 2009 at 11:54 AM

Patchwork sucks. Comprehensive reform that augments what already sucks really sucks.

During campaigns, so far as the infallible legislators are democratic, they place unlimited faith in mankind. But so far as they are socialist, they regard mankind as little better than mud. And once elected, the infallible legislators enter omnipotence over mankind who must submit to the degradation of despotism.

All of these proposals are the high road to communism; legislation will then be–in fact, it already is–the battlefield for the fantasies and greed of everyone.”

Bastiat, The Law

We’re still waiting for falsely promised tax cuts.

a priori TAX REFORM

maverick muse on July 30, 2009 at 12:00 PM

I am quite opposed to Qual, but reject that a patient shouldn’t be told the full story about any condition.

SarahW on July 30, 2009 at 12:00 PM

BLake, to what do you refer?

SarahW on July 30, 2009 at 12:02 PM

Darwin, I won’t expand here because to do so would derail the thread of the evil of Qualy.

SarahW on July 30, 2009 at 12:03 PM

derail the thread *from* the evil that is Qualy, that is. Begging Blake’s pardon.

SarahW on July 30, 2009 at 12:04 PM

The notion that, in a free country, peoples’ lives can be treated as nothing more than a statistical function to guide the manipulative efforts of a master class, should be seen as unambiguous evil.

Americans are not cattle to be herded and graded and sorted according to our masters’ criteria.

LimeyGeek on July 30, 2009 at 12:05 PM

SarahW on July 30, 2009 at 12:00 PM

What does THAT have to do with people being FORCED to abort children who have birth defects?

Lily on July 30, 2009 at 12:05 PM

“Evil” is a word I seldom use. But ObamaCare is EVIL. If ever there was evil, this is it.

petefrt on July 30, 2009 at 11:49 AM

I agree. I don’t like to overuse the word evil either, but I think socialism, particularly Obama’s brand of socialism qualifies.

I once read a very good philosopher of religion who described evil as “self-organizing form” or something like that. His point, if I understood it, was that real life creates systems and processes that are naturally good precisely because these systems accrue over time, and are the product of real people’s lives and struggles. A culture is built bit by bit over many centuries. These are the true, good, and beautiful forms in the world. They’re not perfect, but their imperfection actually enhances their beauty.

Self-organizing form is more like a theory that looks good on paper, but it comes from the mind of a kind of person who has no patience for the people around him; these “formless forms” come from the minds of people who believe they are above inconveniences like Divine Will or Providence. Christians often define the evil of Original Sin as man’s stealing the prerogatives of God, deciding that man himself is able to decide the course and outcome of the universe. This attitude has all the outward appearance of form, it’s more or less coherent. It appeals to the common man, and can fool many. But it’s empty. This self-organizing form is like a clone of the good but because it doesn’t come from a humble heart, it’s a prescription for death. And in the hands of the leader of the most powerful nation on earth, it’s a recipe for death on a very large scale.

jeff_from_mpls on July 30, 2009 at 12:06 PM

jeff_from_mpls on July 30, 2009 at 11:52 AM

yes.

maverick muse on July 30, 2009 at 12:07 PM

I am quite opposed to Qual, but reject that a patient shouldn’t be told the full story about any condition.

SarahW on July 30, 2009 at 12:00 PM

I agree. It’s called “Informed Consent” and any physician must be open and honest with their patient about any medical condition, as well as the possible risks and possible benefits of treating the condition, including the risks and benefits with NOT treating the condition.

And it should be a discussion between a doctor and their patient, not a letter sent to a doctor and a patient from a glorified DMV employee denying care because it isn’t cost effective enough.

DrAllecon on July 30, 2009 at 12:10 PM

If QALY considerations were in full effect here, Professor Steven Hawkings would be dead by now. Probably many years ago.

AW1 Tim on July 30, 2009 at 12:10 PM

There are no unalienable rights according to Rousseau, Marx and Socialists.

That there ever were is a mere myth, opium for the masses.

Human dignity is a figment of the imagination.

maverick muse on July 30, 2009 at 12:10 PM

This is something that has bothered me greatly and still does. I REALLY don’t want anyone other than me and my doctors making decisions about my care. I don’t want a QALY score a for me or for the care that I may or may not get.
And I guess I’m still confused. Say I have congestive heart failure. I’m rushed to the hospital, will the score be based on me and my age and basic health to that point or the costs and treatments of CHF, considering more often than not CHF is seen in the elderly? Scares me a little…I had CHF at 25 and costs to me and ins were high. But here I am 11 years later and I don’t want some fool in DC saying I can’t have care because it’s on the BS QALY chart.

mauioriginal on July 30, 2009 at 12:10 PM

mauioriginal on July 30, 2009 at 12:10 PM

And those requiring organ transplants would be written off after their bodies reject their first surgery and only shot. Quota and limits.

maverick muse on July 30, 2009 at 12:14 PM

What occurs to me is that the QALY exists and is being used, regardless of the Obama healthcare plan. Our current private insurers have to make these kinds of choices when making corporate HMO plans. And we need them to do so, to keep the cost manageable.

In either the current scenario, or the Obama plan, there will be procedures that are not covered, for which one must pay out of pocket. I cannot believe that that option would be procluded by law. That threshold might move in either direction. Given the nature of beaurocracy, it would have to move toward being more restrictive to break even. But public sentiment would push back, and probably not let it change much, which eventually simply causes it to be more expensive.

Sorry, but I just don’t see QALY as a rationale for the current healthcare debate. I am totally against the new plan, but that is because it is in opposition to free-market economics. Of its nature, the new plan will be more expensive and cumbersome.

connertown on July 30, 2009 at 12:16 PM

And it’s a very easy and rather short step from using QALY to rate the quality of life based upon the treatment considered, to rating your continued worth to the state.

AW1 Tim on July 30, 2009 at 12:16 PM

If QALY considerations were in full effect here, Professor Steven Hawkings would be dead by now. Probably many years ago.

AW1 Tim on July 30, 2009 at 12:10 PM

Damn you! That was the very first thought that popped into my head as well!
Think about the cost to society had he been offed!

redshirt on July 30, 2009 at 12:18 PM

BLake, to what do you refer?

SarahW on July 30, 2009 at 12:02 PM

Your comments at the times that I already quoted for you. I can make no more detailed reference because nobody knows what the hell you are trying to say.

Blake on July 30, 2009 at 12:18 PM

Wow, I just had another thought. Where does organ donation factor in to this cold blooded calculation?
A person has a low QALY, but his organs are ripe for the harvest. Will viability of organ donation somehow figure in to any decisions a government toady makes?

redshirt on July 30, 2009 at 12:21 PM

I’m pretty sure that we’re all just going to be walked into a doctor’s office and forced to take one of those online “when will you die” quizzes to figure out our last year of life:

http://www.deathclock.com/

Most technological administration EVAH!

Sir Corky on July 30, 2009 at 12:21 PM

Wow, I just had another thought. Where does organ donation factor in to this cold blooded calculation?
A person has a low QALY, but his organs are ripe for the harvest. Will viability of organ donation somehow figure in to any decisions a government toady makes?

redshirt on July 30, 2009 at 12:21 PM

That’s an excellent, really scary point. And will organ donation be mandated? Some religions don’t allow organs to be harvested, but not any of the religions that liberals “respect.”

On another note, I wonder if organ donation will count as my “volunteer service” so I won’t have to worry about it until I’m dead.

Sir Corky on July 30, 2009 at 12:28 PM

DrAllecon on July 30, 2009 at 12:10 PM

I agree that the decision should be between the patient and the doctor. However, they are doctors, not psychics, so they don’t always know how things are going to turn out. It has certainly been my experience that, to cover themselves from lawsuits, they always give the most pessimistic outlook.

I am pretty sure that the most pessimistic of the pessimists will be in charge of QUAL.

Lily on July 30, 2009 at 12:30 PM

Our goddammed uneducated culture lops it up like dogs. Except actual dogs will get better health care than the imbeciles who are support this evil, evil program.

jeff_from_mpls on July 30, 2009 at 11:52 AM

They do. I listened to callers on a talk radio show yesterday. One of the “youngsters” in favor of BOcare said that it was, “Too bad for old people. They’re old, anyway.”

He was barely literate, knew no details yet clearly had no problem with letting the elderly suffer and die.

Cody1991 on July 30, 2009 at 12:32 PM

This is Ted Kennedy’s dream for America. For the rest of us, that is.

Imagine if Ted were put through this process with his latest affliction. He’s was diagnosed with a brain tumor after he was into his 70′s. He’s still alive after receiving the best medical attention available. For us, the story would be different. As BO said it might be just as well to take a pain killer and live with it – for as long as it takes you to die.

Cody1991 on July 30, 2009 at 12:37 PM

LimeyGeek on July 30, 2009 at 12:05 PM

Airlines have been doing that for years.

OldEnglish on July 30, 2009 at 12:43 PM

Airlines have been doing that for years.

OldEnglish on July 30, 2009 at 12:43 PM

Golden Banana

LimeyGeek on July 30, 2009 at 12:47 PM

it’s a prescription for death. And in the hands of the leader of the most powerful nation on earth, it’s a recipe for death on a very large scale.

jeff_from_mpls on July 30, 2009 at 12:06 PM

Yes, but I’m convinced that there is a larger agenda here. There is no reason to replicate failed policies, however the Dems are dedicated to do so. The UK is their model. I have relatives there, and I’ve seen what NuLabor has done over the years. Brits had a reprieve during the Thatcher years, but they back-tracked with Blair and Brown.

My relatives come to the US for medical attention. In one case it was a life-threatening situation.

The additional toll that socialized medicine takes is psychological, imo. When the most personal decisions of one’s life are no longer personal but the domain of government bureaucracy, people view their lives and aspirations differently. You are no longer an individual. That is what made this country great, and once it’s ripped away from us we are forever changed.

Cody1991 on July 30, 2009 at 12:49 PM

Those of you who did not protest when “quality of life” arguments were used to justify abortion – now those same standards will be applied to you. How does it make you feel?

How will qaly be calculated for two men facing an identical serious medical situation who are are identical in age and health, but one has a PhD from Harvard and the other is a high school drop out?

ksm on July 30, 2009 at 12:51 PM

No words…..just no words can describe the visceral anger I felt as I read this. How DARE these bastards…..I make the decisions regarding what constitutes “Quality” in my life.

Fighton03 on July 30, 2009 at 12:56 PM

…once it’s ripped away from us…

…we roll up our sleeves, load our guns, and go to war.

LimeyGeek on July 30, 2009 at 12:56 PM

LimeyGeek on July 30, 2009 at 12:56 PM

You’re in TX, aren’t you? I’m thinking of relocating there. If BO manages a second term, the best places to live will probably be TX or AK. :))

Cody1991 on July 30, 2009 at 1:00 PM

Golden Banana

LimeyGeek on July 30, 2009 at 12:47 PM

I’m old, and no geek. What does a strip club have to do with statistics?

OldEnglish on July 30, 2009 at 1:03 PM

I’m telling you, there is an ideology behind this QALY……..

Seven Percent Solution on July 30, 2009 at 1:04 PM

Cody1991 on July 30, 2009 at 1:00 PM

Not Texas (a wee bit NE)….but I’ve got my eyes fixed on the Lonestar State.

LimeyGeek on July 30, 2009 at 1:04 PM

I agree that the decision should be between the patient and the doctor. However, they are doctors, not psychics, so they don’t always know how things are going to turn out. It has certainly been my experience that, to cover themselves from lawsuits, they always give the most pessimistic outlook.

I am pretty sure that the most pessimistic of the pessimists will be in charge of QUAL.

Lily on July 30, 2009 at 12:30 PM

You’re right, certainly doctors can only predict just so much based on previous experience, and sadly most do tend to lean toward the glass is half empty end of the predicitoni range so as to cover themselves and not to build up expectations that are too high.

And you can bet that the people in charge of QAYL will be pessimestic since that’s the most cost-effective way (being an optimist costs money, lol) I’m afraid that the people in charge won’t necessarilly be doctors though.

More like DMV employees with a printed out list and flowchart next to their telephone. ::scanning list:: “Oh, you’re (insert age) and you smoked since (insert age)? Well, that qualifies you for (insert $ amount) of coverage. Oh, you keep your blood pressure under control with diet instead of medication? Well that adds back (insert $ amount) credits back. You can have your gallbladder out after all, congratulations!”

DrAllecon on July 30, 2009 at 1:05 PM

More like DMV employees with a printed out list and flowchart next to their telephone. ::scanning list:: “Oh, you’re (insert age) and you smoked since (insert age)? Well, that qualifies you for (insert $ amount) of coverage. Oh, you keep your blood pressure under control with diet instead of medication? Well that adds back (insert $ amount) credits back. You can have your gallbladder out after all, congratulations!”

DrAllecon on July 30, 2009 at 1:05 PM

The DMV analogy is the one I have consistently used when talking to people about this plan to reform health care. I’ve never met anyone who doesn’t dread having to go to the DMV, but one normally doesn’t go there often. It usually isn’t a serious situation.

Imagine having to encounter the same type of bureaucracy, sullenness and lack of interest when one’s health is involved. This plan is a complete nightmare – in every respect. Once it’s in place it will be nearly impossible to dissemble.

Cody1991 on July 30, 2009 at 1:12 PM

Imagine if Ted were put through this process with his latest affliction.

Cody1991 on July 30, 2009 at 12:37 PM

Senator, according to QALY, you have lived 55 years beyond your usefulness to society and, according to the QALY Cap&Trade crosstab, we must terminate your personal CO2 production immediately.

I have a rather vivid imagination.

bloviator on July 30, 2009 at 1:17 PM

The DMV analogy is the one I have consistently used when talking to people about this plan to reform health care. I’ve never met anyone who doesn’t dread having to go to the DMV, but one normally doesn’t go there often. It usually isn’t a serious situation.

Imagine having to encounter the same type of bureaucracy, sullenness and lack of interest when one’s health is involved. This plan is a complete nightmare – in every respect. Once it’s in place it will be nearly impossible to dissemble.

Cody1991 on July 30, 2009 at 1:12 PM

I’m just not ready for my healthcare to be as efficient as the US Postal Service, comapssionate as the IRS or as easily accessable as the DMV. But I don’t think there’s much I can do about it. Elections have consequences and some are more severe than others.

DrAllecon on July 30, 2009 at 1:24 PM

I have a rather vivid imagination.

bloviator on July 30, 2009 at 1:17 PM

Same here. I also have strong opinions and had a few ideas about what should have happened to Splash a long time ago. As a woman it’s difficult to have a dispassionate view of this chap.

Cody1991 on July 30, 2009 at 1:34 PM

This is sickening.
jeff_from_mpls on July 30, 2009

Every bit of the hope and change we are getting is quite sickening. We have lost ALL of our freedoms and it seems at least half the population supports this.

If you know the history of Chavez in Venezuela and the dynamics of his support/opposition….it is eerily similar to what we have here. Chavez championed the poor and proceeded to engineer many more into poverty thereby garnering a larger natural support base. So actually more people in Venezuela support Chavez than oppose him.

The next step in Obama’s marxist march will be to jail and intimidate dissidents. If Americans are the “exceptional” people we claim to be….at what point do we rise up against this?

Goodeye_Closed on July 30, 2009 at 1:51 PM

The goal is to provide them with a common denominator in measuring benefits — how many years of life is expected to be gained in a patient if we give him this treatment? But the QA part says not all years are equal, nor is an additional year of life in a healthy 25-year-old male equivalent to that of a 55-year-old parapalegic female. You have to adjust for quality.

Aside from the moral objections, aside from the U.S. Constitution; unlike “how many years of life”, “quality” can not even be judged objectively as it is so very subjective.

HalJordan on July 30, 2009 at 2:14 PM

But…but… Obama insists that nothing will change in our health care…..It isn’t govt. run health care …. It will save the economy …. It will keep the oceans from rising (Oh wait, the last one is what he says about cap & tax.)

We are gagging on his lies.

Christian Conservative on July 30, 2009 at 2:14 PM

I wonder how an “adjust for quality” would be made for a Michael Jackson? Pretend that he is still alive. How high a quality of life could someone that hideously ugly have? Especially when he had been good looking after a few plastic surgeries, but then had about a hundred more and made himself hideously ugly and had to live with the burden of having done that? How high could the “quality of life” be for Sonya Sotomayor as homely as she is or for Ruth Ginsberg as extremely ugly as she is? Or for Barney Frank or Henry Waxman? Frankly I think I would rather be dead than look like Henry Waxman.

HalJordan on July 30, 2009 at 2:27 PM

Professor Banian:
.
Thank you for this excellent post and for your daily commitment to present issues with openness and integrity. Everyone notices the orthodoxy of thought within the left/MSM alliance — but there is quite a bit of fixed thinking on the right as well. Your approach is refreshing.

Mark30339 on July 30, 2009 at 3:49 PM