Wednesday, June 3, 2009


That question has been rattling around my brain box for some time now. While it may seem obvious that the answer is "A human life is priceless," a moments thought reveals that "priceless" carries with it a very steep price that we Americans pay in the social policies that we all must live with.

Take medicine. The idea that the adoption of a European type universal health care system will result in rationing (see my post here) only makes sense if you realize that what is meant is rationing of the best care. The government can't be the insurer of last resort because the country would go broke, say the anti universal care types. And since we wouldn't want that, some people (read poor) will be denied care. But the care they are referring to is the best care available. You see, if every human life is priceless, to deny or ration the best care to anyone is to cheapen that human life.

The idea works like this. Comparing treatment "A" with treatment "B" as to their efficiency will lead to the conclusion that, of course, we should use whichever is the most efficient. But what happens when we compare their cost effectiveness? If "B" is 10% more effective but costs 10 times as much as "A" should we still choose "B"? How about if the patient is willing to pay the difference? How about if the taxpayers (you) are picking up the tab? Every life is priceless. With "A" you'll live 30 more days. With "B" you'll live 33. Which makes more sense?

That, in a nutshell, explains one of the many hard questions we will face as we try to solve the health care crisis. Great Britain has dealt with this as it relates to drug costs by setting up a body called the National Institute for Health and Clinical Excellence (NICE). See this Time story for some details. NICE uses a formula to compare "A" and "B" and approves or disapproves any new drug or treatment. That is, whether or not the National Health Service will pay for the drug or treatment. Rationing. Why would we ever want to adopt such a scheme here in America.

Sir Michael Rawlins, chairman of NICE, believes that if the U.S. adopted a similar system, it would revolutionize the culture of major pharmaceutical companies, many of which spend more on marketing than research and development. A 2008 study in the New England Journal of Medicine predicted that incorporating information about cost-effectiveness into the design of U.S. insurance would save $368 billion over 10 years.
Oh ya, that's why. I'm afraid that for this country to be able to afford universal health care we are going to have to come to grips with the idea that "Every life is priceless." We're going to have to make the hard choices about quality of life vs. cost of care. We're going to have to put a price on a human life. Do we have the courage to do that?

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