Human Exceptionalism

Here Comes “Expected Life Years” Rationing

The researchers are busy creating computer models and testing hypotheses to see if they can predict mortality accurately–as a way, I suspect, of justifying health care rationing. My concern was heightened by a study just published as a letter in the March 6 Journal of the American Medical Association, in which the authors claim that they were able to predict likely mortality 10-years out. From, “Predicting 10-Year Mortality for Older Adults:”

Extending the index from 4 to 10 years did not diminish the model discrimination (validation cohort,C statistics 0.817 vs 0.834; P= .35), suggesting that the risk factors important for 4-year mortality prediction are also important for 10-year mortality prediction. The model compares favorably with other mortality indexes that predict mortality beyond 7 years…Patients identified by this index as having a high risk of 10-year mortality may be more likely to be harmed by preventive interventions with long lag times to benefit, whereas patients identified as having a low risk of 10-year mortality may be good candidates for such interventions.

Thus, (say) if a colonoscopy is identified as not having a positive cost benefit for seven or more years (as the article indicates), such screening for those whom the computers predict are likely to die within ten years might not be covered. Why? Both because the potential immediate risk of harm from the test or a false positive is deemed more likely than an actual health benefit, and because your lower overall predicted life expectancy means that the statistically unlikely chance of catching a cancer among your cohort is not worth the cost of all those screening tests. 

In essence, this approach would seem to be pointing toward an “expected life years” form of rationing (let’s call it) under Obamacare, with decision-making based in large part on cohort membership and computer model projections.

If an expected life years form rationing is ever accomplished, the next step will be the even more subjective quality adjusted life year rationing model, already in use in the UK. Fasten your seat belts, it’s going to be a bumpy ride. 

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