Governments that determine treatments using the QALY assign a dollar value to a year of perfect health (in Britain, it’s about $50,000 a year) and then generally reject treatments that don’t provide enough value. This means, among other things, that expensive treatments for older individuals are less likely to be funded. From a rational economic standpoint, spending, say, $200,000 to save the life of a 78-year-old only expected to live three more years really is less efficient than spending the same amount on a 30-year-old who’s likely to live 40-some more years.
What’s wrong with this approach? Beyond the inevitable disputes between economists about what a year of life is actually worth, the bigger issue is that the QALY standard results in an essentially command-and-control approach to health-care distribution: Rather than let individual preferences and agreements work out prices and reach an equilibrium, the government simply sets the value of a year of good life for all people, without differentiating between them, and extrapolates from there. I agree that, in the end, we do have to make economic decisions about the value of life. But shouldn’t those be decisions made by individuals, their families, and their doctors? Do we really want bureaucrats in Washington handing down indiscriminate dictates on what a year of productive, healthy life is worth? Must everyone be blindly herded into the same pen? To the extent that we have the government involved in health-care decision-making, we probably should expect some level of rational economic prioritizing. But this seems to me like an argument to keep the government out of these decisions as much as possible.