Biting the Bullet

Well, this had to happen eventually. That tulip-infested land beyond (and below) the sea may be the first. A report done for the Netherlands government concludes that the public health insurance system should no longer cover treatments that cost more than 80,000 Euros (about $105,000) per Quality Adjusted Life Year. (If you are up on your Dutch, you can read it at www.rvz.net, as the publication entitled Zinnige end duurzaame zorg. Since my Dutch is a little rusty, I'm getting my summary from Tony Sheldon in the new BMJ.)

Here's the straight dope, folks. Resources are not infinite. You can always spend more and get a slight chance of a few more weeks of survival. In fact, that's all that most of the latest breakthrough cancer treatments offer -- the ones that merit screaming headlines in your daily papers. They extend life by three or four months, at the cost of tens of thousands of dollars. If we don't want health care to consume the entire economy, we have to figure out how to draw the line. Right now, it's done by social class and privilege, happenstance, media feeding frenzies, custom and habit. The report from the Dutch Council for Public Health and Health Care lays it down: 80,000 Euros for another year of tilting at windmills.

Where to they get that number from? I dunno. What it really ought to be is a political question, and I can't imagine we'll ever successfully get through that debate, here in the land of deepest denial and infinite entitlement. But that number, whatever it is, needs to be pulled out of its hiding hole and exposed to the light. Right now it's about 50 cents for a poor kid in Africa, and half a million dollars for a well insured American. That ain't right.