The Centers for Medicare and Medicaid Services have indicated that they might impose discriminatory guidelines in the latest round of Medicare drug pricing negotiations. These guidelines would unfairly prioritize the care of certain patients over others, going so far as to deny coverage for the treatment of patients who are deemed “too expensive” to receive care.
This might sound like the plot of a dystopian film, but the potential consequences are all too real for millions of Americans who are already facing record-high costs heading into 2024.
One particularly concerning guideline is the quality-adjusted life years, also known as the QALY metric. QALY assigns a dollar value to various treatments, often undervaluing the lives of the elderly or acutely ill. Under this system, a young, healthy person’s prescription drugs and treatment would be priced lower than those of an elderly person with the same ailment.
This is the disturbing outcome when a flawed algorithm determines the worth of a person’s life. The QALY reduces each patient and treatment to a set of numbers, threatening to effectively deny access to potentially life-saving treatments to the ill or chronically disabled.
Equally dangerous is the calculation of expanded life years gained, or “evLYG,” which determines how much a medical treatment can extend a person’s life without considering quality of life. This singular focus robs patients of the autonomy to have a say in their own healthcare treatment.
Under this system, older or chronically ill patients are often denied the chance to try certain treatments or drugs because evLYG deems them “not worth it,” even when they may otherwise be recommended by the patient’s physician.
It is unfathomable that anyone besides a patient, their family, and their physician should be allowed to determine “worth” when it comes to access to a potentially lifesaving treatment. Neither the QALY nor the evLYG should be a barrier to care prescribed in the patient’s best interests by medical professionals.
At their core, QALY and evLYG are discriminatory and reflective of a warped value system that reduces human life to calculated returns on investment. Far from helping make healthcare more accessible, guidelines like these push us even further from the patient-centered approach our healthcare system desperately needs.
Assigning care based on calculated value is a slippery slope and belies a much darker way of thinking – one that makes it acceptable for us to decide whose suffering is more important, whose life is worth investing in, and at what age a person stops being “worth it.” This directly contradicts the values of equality on which our nation was founded, and strips patients of the individuality, respect, and dignity that they are owed.
If Medicare were to incorporate QALY and evLYG into its drug pricing, the elderly and disabled would suffer the most – the same population that Medicare is meant to serve. It is critical that we work against these inhumane metrics and build a system that will empower every patient, regardless of age or condition, to access the care that they deserve.
Dr. Chris Stansbury is a partner at West Virginia Eye Consultants and a partner of the Job Creators Network Foundation.
