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Report: Controversial Drug Rationing Scheme Eyed By Trump, Biden Administrations

Expert panels decide whether extra years added by certain treatments worth the cost

A controversial method used by some countries’ government-organized health care systems to determine whether certain patients will get expensive life-saving treatments could become an issue in this state and country.

According to a new report from the Goldwater Institute, both the Trump administration and the new Biden administration have proposed or considered using review panels to decide whether America’s Medicare and Medicaid programs should pay for certain treatments.

Under this system, the panels assess and judge whether a drug or treatment is worth its cost in terms of the value it offers for patients. The key measurement is called “Quality-Adjusted Life Years,” or QALY.

The report notes that President Joe Biden’s medical and COVID advisory teams include some high-profile advocates for limiting care for people at the end of life.

One of them is Dr. Ezekiel Emanuel, a University of Pennsylvania oncologist who has been at the center of controversies over so-called death panels under the Affordable Care Act. Separately, he wrote a lengthy article on the limited value of medical interventions for people beyond a certain age. It was called “Why I Hope to Die at 75.” The article itself did not make public policy recommendations.

Evaluating the cost and benefits of drugs and treatments is a necessary component of health care decision-making, said Naomi Lopez, a co-author of the report, “Deciding What a Life is Worth.” Lopez is the director of health care policy at the Goldwater Institute.

Lopez says says it is both morally and medically suspect for government-managed systems to set up rigid measurements like QALY to assess the value of specific treatments for the aged and infirm.

“A QALY value assessment that assigns lower monetary values for the life years of the disabled, ill and aged intends to ration care to those populations,” according to the report.

Lopez said in an interview that the QALY approach has three major deficiencies:

● It shortchanges methods of evaluating treatments that don’t target the vulnerable.

● It establishes bureaucratic barriers to the evaluation and implementation of medical innovations.

● It interferes in the doctor-patient relationship in reaching conclusions about the most effective treatment for specific conditions in specific patients.

When government-run health systems in other countries use QALY, the inevitable result is inequitable access to lifesaving drugs and treatments, the Goldwater report found.

Lopez said the Affordable Care Act, also known as ObamaCare, bars Medicare from using QALY or similar metrics. (Medicare is the program that insures elderly Americans.) Some states have extended the prohibition to state-run programs, with Oklahoma being the most recent example, enacting it last year.

Michigan does not use QALY for treatment decisions in the state’s Medicaid program, state officials told Michigan Capitol Confidential last year.

But Lopez said the pressure for both state and federal officials to contain health care costs continues to escalate. As that happens, the temptation to adopt standards that discriminate against vulnerable populations intensifies.

As Lopez concludes in her report, “QALYs are a perilous prescription that not only undermine accountability, they move us further away from getting the right treatment, to the right patient, at the right time.”

Michigan Capitol Confidential is the news source produced by the Mackinac Center for Public Policy. Michigan Capitol Confidential reports with a free-market news perspective.