Don’t Let Progressives Assign A Dollar Value To Human Life

How do you measure a year? Your desk calendar might suggest months or days. The musical “Rent” famously offered 525,600 minutes and a number of other more creative metrics.

Ask a progressive health policy expert, though, and they may give you the most shocking option of all. For years, progressives have attempted to build their policy proposals around “quality-adjusted life years,” or QALYs. This approach ostensibly assigns a dollar amount to a year of human life.

Many Americans find that kind of calculation grotesque. And a substantial portion of Congress does, too. Last month, the House Energy and Commerce Committee approved a bill that would bar federal agencies from using QALYs to evaluate the cost-effectiveness of drugs and treatments.

That’s good news for patients. QALYs are a pseudoscientific and inhumane way to make decisions about medical treatment. In countries where regulators rely on these metrics to determine patient access to drugs, they almost exclusively lead to the denial of life-saving treatments. Keeping QALYs out of the United States will save lives.

QALYs are calculated by determining how many extra years of life a treatment will give a patient—and what the quality of those years will be. “Quality” in this case is determined by a patient’s ability to carry out commonplace activities efficiently and painlessly. In this system, a QALY value of one is equal to one year of perfect health, while a value of zero is equivalent to death.

In the United States, no group has done more to push QALYs on patients than the Institute for Clinical and Economic Research, or ICER. Whenever the Food and Drug Administration approves a new drug, ICER dutifully cranks out a report on the drug’s “cost-effectiveness,” which it determines using QALYs. Under ICER’s “value assessment framework,” one QALY is worth between $100,000 and $150,000.

This subjective analysis has a number of potential drawbacks. Most worrisomely, QALYs undervalue elderly or disabled people, or patients with chronic diseases. Because it costs more to even bring these individuals back to what ICER and others deem a “quality” year of life, most of the drugs that can improve or alleviate certain conditions—from Alzheimer’s and cancer to rare diseases—do not pass the value test.

That’s one reason House Energy and Commerce Committee Chair Cathy McMorris Rodgers, R.-Wash., and her cosponsors in January introduced the Protecting Health Care for All Patients Act. The bill would extend Medicare’s limited prohibition of QALYs throughout all federal programs, to ensure no government regulator can use the metrics to determine coverage, which the bill’s cosponsors call “a clear form of discrimination.”

Predictably, QALY proponents rushed to oppose the bill, claiming that QALYs can actually save lives and help patients with rare or chronic conditions access expensive drugs.

The evidence from countries where government bureaucrats use QALYs and similar metrics to shape health coverage would seem to indicate otherwise.

A 2016 study concluded that the single-payer healthcare system in my native Canada maintained a cost-effectiveness threshold of roughly $50,000 Canadian per QALY. That’s less than $37,000 in U.S. dollars at today’s exchange rates.

The threshold in Great Britain was just $36,000 per QALY and in Australia just $47,000 per QALY, according to a 2020 study.

These policies have devastating results. In September 2022, the National Institute for Health and Care Excellence—with its Orwellian acronym NICE—deemed a new drug for prostate cancer too expensive for England’s and Wales’s National Health Service to cover. That same year, Canada’s healthcare system blocked a man battling cancer from accessing a lifesaving drug the government had already approved because it was too expensive.

QALYs are just one metric that officials in government-run health systems use to deny coverage for drugs they deem “too expensive.” And since the government is the only buyer in these countries, when health systems don’t cover a drug, patients don’t have access to them.

The same thing would happen in the United States if bureaucrats had the ability to use QALYs to inform decisions about whether to cover certain therapies. By working to keep these metrics out of the United States, Rep. McMorris Rodgers and her colleagues are helping to ensure that Americans continue to have access to the best medical science has to offer.