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Thanks for posting the article on QALY measurement by Tom Miller. He has been a perceptive analyst of healthcare for a long time.
In my opinion, much of the opposition to QALY derives from a nostalgic view of America as the land of ultimate individual rights. As far back as the 1950’s, America seemed to stand for the principle that we can and should do anything possible to save an individual life. This view assumes that we can always find the money somewhere for a miracle cure.
The more European-type view is that the money for health care is limited, and if we spend $1 million a year on one person then there will be less money for others. This acceptance of limits means that we might have to let one person die if we want to provide comfort and healing to a thousand or even 10,000 patients with more minor illnesses.
This clash of principles came up during the right-to-die cases like Terry Schaivo and Karen Ann Quinlan. The opposition to using any rationing like QALY was very strong then and it is still strong today.
I was disappointed in the Robert Moffitt article about Medicare spending at the top of yesterday’s links. He was correct about the problem of growing costs, but frankly kind of watery about any solution.
He praised Medicare Advantage plans. These plans have many good features — I have been in such a plan for all of my ten years on Medicare.
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But Moffitt is just careless to imply that Medicare Advantage will produce lower federal costs. At one point the M.A. plans were just out-and-out paid about 10 per cent more than the average cost of traditional Medicare. In recent years, many MA plans have been credibly accused of exaggerating the health risks of their clientele and getting more federal money in that way.
To paraphrase Michael Corleone when he confronted Carlo Rizzi, “Don’t tell me you’re innocent, because it insults my intelligence and makes me very angry.”