Wednesday, July 8, 2009

How much are six months worth?

The Wall Street Journal describes how health care rationing works in the United Kingdom:
.... What NICE has become in practice is a rationing board. As health costs have exploded in Britain as in most developed countries, NICE has become the heavy that reduces spending by limiting the treatments that 61 million citizens are allowed to receive through the NHS. ....

.... [NICE] has by now established the principle that the only way to control health-care costs is for this panel of medical high priests to dictate limits on certain kinds of care to certain classes of patients.

The NICE board even has a mathematical formula for doing so, based on a "quality adjusted life year." While the guidelines are complex, NICE currently holds that, except in unusual cases, Britain cannot afford to spend more than about $22,000 to extend a life by six months. Why $22,000? It seems to be arbitrary, calculated mainly based on how much the government wants to spend on health care. That figure has remained fairly constant since NICE was established and doesn't adjust for either overall or medical inflation.

Proponents argue that such cost-benefit analysis has to figure into health-care decisions, and that any medical system rations care in some way. And it is true that U.S. private insurers also deny reimbursement for some kinds of care. The core issue is whether those decisions are going to be dictated by the brute force of politics (NICE) or by prices (a private insurance system).

The last six months of life are a particularly difficult moral issue because that is when most health-care spending occurs. But who would you rather have making decisions about whether a treatment is worth the price — the combination of you, your doctor and a private insurer, or a government board that cuts everyone off at $22,000? ....

Mr. Obama and Democrats claim they can expand subsidies for tens of millions of Americans, while saving money and improving the quality of care. It can't possibly be done. The inevitable result of their plan will be some version of a NICE board that will tell millions of Americans that they are too young, or too old, or too sick to be worth paying to care for. [more]
How much are six months worth? And who should decide?

Wesley J. Smith, responding to another advocate of limiting "end-of-life" care, and drawing the logical—disturbing—conclusion:
I am all for hospice care and refusing unwanted ICU—if that is what the patient wants. As long time readers know, I have been a hospice volunteer. My dad died of colon cancer receiving hospice as have other relatives and very close friends. But here’s the thing: Once we say that a life is not worth preserving based on costs, we have instituted explicit rationing and created a duty to die.

The doctor then talks about a “well thought out plan” for end of life care and the signing of advance directives. Again, I’m all for it, but recall that there are many forces wanting to give faceless bioethics committees the right to veto your desires—even if set in writing. ....

.... [T]hink of all the money to be saved if instead of hospice or an extended time of debilitation we could give the patient a lethal jab or a poison brew! Indeed, it’s already happening: Recall, in Oregon, Medicaid has refused life-extending treatment to cancer patients but explicitly offered to pay for assisted suicide. Not that assisted suicide will become the cornerstone of health care reform. But make no mistake: It is the monster lurking in the shadows that we ignore at all our peril.

So, here’s the gig as I see it developing: In the new health care order, “choice” will be sacrosanct if the choice is death—either naturally or by lethal means. But if the choice is is to go on living—at a certain point “choice” will cease to be operative because you will have become unwanted ballast. Eventually, that could even mean non voluntary euthanasia as now occurs with regularity in the Netherlands.
Of NICE and Men -, Secondhand Smoke — A First Things Blog

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