Rationing Medical Services By Citizens’ Soviet

Posted by John R. Graham in California, Health Care, Single-Payer Follies on Jun 22nd, 2009 | no responses

Los Angeles Times’ Michael Hiltzik has a column that explains to laymen how the rationing of medical services occurs in government-run health systems, using the example of the Great Britain’s National Institute of Clinical Effectiveness (NICE). The key measurement is QALY: Quality-Adjusted Life Year. It's easy to calculate, if you have the right data. It's getting the right data that's tough. Hiltzik gives the example of chicken-pox vaccine, which looked expensive in the 1990s until health economists also accounted for the costs of parents having to take days off work to take care of kids with chicken pox.

Hiltzik doesn't come across as an extremist, but he hates private insurers, claiming that they place “intolerable obstacles in the way of patients seeking treatments." This is simply not true, in aggregate. The media love to traffic in horror stories, but the simple fact is that advocates of government take-over talk out of both sides of their mouths; on the one hand saying that private insurers cut and run when patients need treatment; on the other hand saying we need the government to decide what medical services we get because the U.S. consumes too much ineffective health care. Come on, guys: Please make up your minds.

Hiltzik also thinks that deciding what treatments get paid for should be decided "in the open air rather than in the counting houses of insurers," which he believes happens in Great Britain because the government was forced to convene a Citizens' Council to propose policies for coverage, after popular outcry against NICE’s rationing grew too loud. Hold your horses: The Citizens’ Council made recommendations last November, but the government never committed to doing anything about them.

The fact is, there is no "right" answer to what a QALY is worth. Insurance decisions should not be made by government monopoly, whether secretly or in the open. The role of government should be to enforce good faith payment of claims according to contractual terms voluntarily made by patients and their insurers.