Human Exceptionalism

The Coming Obamacare Depersonalization

Obamacare means centralized control of health care. Centralized control of health care means patients are viewed as members of categories instead of as individuals. The end of patients being viewed as individuals results in the deprofessionalization of medicine. The deprofessionalization of medicine leads to the reign of high-paid bureaucrats, technocrats, and academics, as they write arcane, jargon-filled reports designed to justify dictats from on high to the trench workers in hospitals and at the clinical setting. And that leads to a meltdown of the system, as is happening in the UK’s National Health Service. 

Here’s a small example: A new article published in the British Medical Journal analyzes how the UK’s rationing board–the National Institute on Health and Clinical Excellence (NICE)–applies ”quality adjusted life years” (QALY) to end of life care decisions. QALYs involve cost-benefit analyses with “quality of life” the determining factor. (See what I mean about arcane jargon?) 

From, “NICE’s End of Life Decision Making Scheme: Impact on Population Health:”

Our analysis shows that use of NICE’s end of life criteria has resulted in substantial QALY losses. We have assumed that the cost of end of life drugs is met entirely through displacement of other services or treatments in the NHS. Although we do not know whether this has been the case, as the NHS budget is under increasing strain, it seems reasonable to assume that disinvestment will be required. To put the losses into context,the £549m that we estimated has been spent on the nine end of life treatments each year is more than the £505m it cost to provide dialysis for the 21,544 patients with kidney failure in England in 2009.

What does society want? The reallocation of resources to end of life interventions maybe acceptable if society truly values QALYs gained through an extension of life when a patient has a terminal illness more highly than those gained at any other time of life. In this case it would be valid to apply weights to QALYs for end of life treatments, and the QALY loss would represent societal preferences.

Talk about eye-glazing! Talk about a bore fest! And therein lies the danger: Talk about losing the humanity of the decisions being discussed! 

But note, what an individual might want with regard to end of life care seems irrelevant. What matters is quality of life and supposed “societal” preference:

Our analysis has shown that if society does not place a higher value on QALYs obtained at the end of life, the application of the NICE end of life criteria is likely to have resulted insubstantial QALY losses and budgetary pressures to the NHS and population in England and Wales, as cost effective interventions are displaced in favour of less cost effective interventions. If society does give more value to QALYs gained by people at the end of life the cost effectiveness threshold may need to change to reflect this.

That’s the kind of dehumanized system that the Obamacarians intend for us. It’s a technocrats full employment law that treats patients as mere potter’s clay. 


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