Map of life expectancy at birth from Global Education Project.

Monday, March 14, 2016

Why we need the death panel

The UK's National Institute for Health and Clinical Excellence, which is abbreviated NICE because a) that sounds, well, nice and b) the word health was added to the name later, is an essential institution. I do not expect to see an equivalent in the U.S. in my lifetime. (I'm not sure if you can get behind the paywall for the link.)

This is a subject I used to write about a lot here and then I figured okay, I've been there and done that. But it was a few years ago and the political context has changed, so I'll revisit. NICE is not actually much like Sarah Palin's imaginary death panels. It doesn't rule on individual cases. (Well, there's a bit of an unfortunate exception, which I will get to, but it has been mostly reversed.) Rather, it decides whether the National Health Service will pay for specific treatments for general classes of people, and yes, it includes cost in the calculation.

I will write about the complexities of this at greater length in future posts, but today I will just set up the basic problem, which is absolutely inescapable. The National Health Service provides comprehensive health care for all of Her Majesty's subjects. The parliament approves a finite budget for the NHS every year. Ergo, said comprehensive health care must have limits, because it must be provided within said finite budget.


Our situation in the U.S. is comparable to the extent that we do provide government funded health care for everybody 65 and older. We do so as an entitlement, which means Congress does not limit spending on Medicare. This means that Medicare has to pay whatever the drug companies want to charge for say, cancer treatments that might extend a person's life by a couple of months. We do not, however, provide universal comprehensive health care to everybody under age 65, the ACA notwisthstanding. And there is a lot more we don't do that the Brits do, even under their current comparatively stingy Tory government. The point being, resources are finite and every country makes political decisions about how much to spend on what. In those decisions, some people die who would not have under a different allocation scheme. There are always death panels, even though they are mostly invisible. There always will be and there always must be.

So, how does NICE actually make these calculations? We'll discuss that next. 

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