The QALY is an attempt to mathematically calculate the financial value of one year of “perfect health.” That number is then used to put an artificial “value” on a treatment based on whether the human benefits outweigh the financial costs. Reducing quality-of-life to a dollar amount is dubious science in any case. But it is QALYs’ devaluing of certain lives – like the elderly, the disabled, the chronically ill – that make patients and their families most vulnerable to discrimination and abuse.
Put simply, QALYs assert that the lives of the infirm are less valuable than the healthy. It’s “a dehumanizing methodology that discriminates against the elderly and the sickest among us,” according to Mary Vought, former member of the National Council on Disability.
Momentum for Reform
QALYs have been restricted in the Medicare program for a decade, under the Affordable Care Act. Taking the next step and striking them from all federal health care programs is the longstanding recommendation of the National Council on Disability. Now, the Protecting Health Care for All Patients Act, introduced in Congress, is ripe for action.
Banning these abusive metrics outright is popular with the public and an urgent priority for a large, diverse coalition of patient and disabled rights organizations. Notably, the bill’s sponsors include influential leaders in the U.S. House of Representatives:
- Rep. Cathy McMorris-Rodgers (R-Wash.), Energy and Commerce Committee Chair: “All lives are worth living… The ‘quality-adjusted life years’ measurement is used to discriminate against people with chronic illnesses and disabilities, like cystic fibrosis, ALS, or Down syndrome, putting them at the back of the line for treatment. Moving this legislation will be a priority for our committee.”
- Rep. Jason Smith (R-Mo.), Ways and Means Committee Chair: “Washington bureaucrats have no business picking and choosing which Americans are worthy of receiving treatment for serious, and often life-threatening, health issues. The ‘quality-adjusted life years’ measurement is discriminatory, morally bankrupt, and has no place in our health care system.”
No Time to Lose
QALY reform is taking on new urgency today as some sectors of the health care system are growing enamored of using these algorithms. For instance, QALY-based analyses by the Institute for Clinical and Economic Review have been used to justify restricting certain patients’ access to drugs and treatments.
The Protecting Health Care for All Patients Act is an opportunity to protect patients, ensure care remains the top priority of our health system and reaffirm America’s commitment to the equal rights and dignity of all.