Human Exceptionalism

Using Computer Models to Ration Health Care?

We discussed the new computer model that supposedly can predict how much longer one has to live in the context of whether a patient should be told they have less than ten years.  But the NYT’s take on the same story raises another issue we only tangentially touched before; whether a computer program predicting how long a patient has to live could be put to pernicious heatlhcare rationing effect, similar to the “quality adjusted life year” (QALY) that was used by NICE to ration medicine in the UK.  From “Using Interactive Tools to Assess the Likelihood of Death:”

Now, researchers at the University of California, San Francisco, have identified 16 assessment scales with “moderate” to “very good” abilities to determine the likelihood of death within six months to five years in various older populations. Moreover, the authors have fashioned interactive tools of the most accurate and useful assessments. On Tuesday, the researchers published a review of these assessments in The Journal of the American Medical Association and posted the interactive versions at a new Web site called, the first time such tools have been assembled for physicians in a single online location.       

“We think a more frank discussion of prognosis in the elderly is sorely needed,” said Dr. Sei Lee, a geriatrician at U.C.S.F. and a co-author of the review. “Without it, decisions are made that are more likely to hurt patients than help them.” Dr. Lee and his colleagues cautioned that while the best assessments are reasonably accurate, there is insufficient data on whether using them improves patient care in clinical settings. The researchers stopped short of urging widespread use.

For now, perhaps. But wait until Obamacare bureaucrats grab ahold.

One doesn’t have to be paranoid to see where this can lead. Under QALY systems, roughly stated, a cost benefit analysis is done to justify providing or withholding an intervention based on the time it is expected to give a patient, adjusted for the quality of life during that time.  Thus, the same intervention that would give me, say, five years of life, might be only worth two years of QALYs if the time would likely include my being disabled.  And something worth five QALYs might be paid for but not something worth two.  The same type of thing could easily be fashioned with this computer model–and don’t think some people aren’t thinking about doing just that.

Do we want people to have information to properly give informed consent and refusal to potential interventions?  Absolutely. Do we want doctors to not offer particular efficacious interventions–or the government/private insurance company refusing to pay for them–because the computer model opined that the patient has a 78% chance of, say, living less than three years?  I think not. Could this kind of information to be used to justify medical discrimination?  You betcha! Indeed, I fear some want to do just that–particularly given the bureaucratic cost saving impetus behind Obamacare’s many cost/benefit panels.

Could this become a hope killer?  You betcha again!  We should tread with very great care here.

Most Popular


Democrats Are Dumping Moderates

The activist base of the Democratic party is lurching left fast enough that everyone should pay attention. Activists matter because their turnout in low-turnout primaries and caucuses almost propelled leftist Bernie Sanders to victory over Hillary Clinton in 2016. Last month, Alexandria Ocasio-Cortez unseated New ... Read More

Questions for Al Franken

1)Al, as you were posting on social media a list of proposed questions for Supreme Court nominee Brett Kavanaugh, did it occur to you that your opinion on the matter is no more relevant than Harvey Weinstein’s? 2) Al, is it appropriate for a disgraced former U.S. senator to use the Twitter cognomen “U.S. ... Read More
Politics & Policy

Strzok by a Farce

An investigation is one of two things: a search for the truth, or a farce. The House is conducting a farce. That fact was on full display during ten hours of testimony by Peter Strzok, the logorrheic lawman who steered the FBI’s Clinton-emails and Trump–Russia probes. The principal question before the ... Read More
Film & TV

Stalin at the Movies

Toward the end of The Death of Stalin, two Communist Party bosses size up Joseph Stalin’s immediate successor, Georgy Malenkov. “Can we trust him?” one asks. “Can you ever really trust a weak man?” his comrade answers. Good question. Last week brought the news that the head of Shambhala ... Read More