At a time of great uncertainty for the public health of our nation, the path to protect patients in Connecticut from unfair and even discriminatory healthcare rationing is clear. And it begins with turning away from European models that rely on controversial approaches to determine the price and value of new drugs. The Connecticut General Assembly can take a different approach and become the next state to protect vulnerable patients from a discriminatory and harmful methodology to determine drug access and value.
The “Quality Adjusted Life Years” (QALY) methodology is commonly used in European countries as the basis for healthcare pricing, leading to decisions that are inherently biased against older people and those living with disabilities. The QALY values treatments based upon their ability to extend life and to improve the quality of life. The evidence shows that the QALY discriminates against older Americans and may even violate the Americans with Disabilities Act (ADA). President Biden made headlines during his campaign when he proposed adopting a similar European model as a way to control drug prices in the U.S.
Here in the U.S., states are starting to take notice to the biased nature of the QALY. On May 22, 2020, Oklahoma Gov. Kevin Stitt signed the “Nondiscrimination in Health Care Coverage Act” into law, which prevents any state agency from utilizing the QALY methodology as a basis for healthcare decision-making. The new law represents unprecedented anti-discrimination protections for those living with disabilities and for older Oklahomans.
Oklahoma’s adoption of such groundbreaking protections must be embarrassing for coastal elites who are always self-reverential about the alleged compassion of their progressive politicians. In fact, what the pandemic has exposed is that these liberal states are not terribly eager to protect their senior and disabled populations and were quick to embrace the cold-hearted rationing schemes common in many nations with socialized medicine.
Consider Massachusetts. In early April 2020, in what can be thought of as the relatively early days of the COVID-19 pandemic, the state’s department of health issued guidelines on how to ration care if hospitals became overwhelmed. The state’s advice? Dispense treatment with a view toward “saving the most life years” -– in other words, if the going gets tough, throw seniors under the bus. Other recommendations in the guidelines would have given lower priority to saving patients with disabilities.
Ultimately, the state had to revise the guidelines due to outrage from the senior and disability rights communities. But note the contrast with Oklahoma, where they are affirmatively preventing seniors and the disabled from being forced to the back of the line.
The Massachusetts example is a minor mishap compared with the “single dumbest decision” made during the entire pandemic: New York’s requirement that COVID-19 patients be accepted by nursing homes. The Associated Press reported in late May of last year that, under the state’s requirement, 4,300 coronavirus patients were sent to the state’s “already vulnerable nursing homes,” a decision that “accelerated the nation’s deadliest outbreak.” Rather than offering anti-discrimination protections for their seniors, New York deliberately created viral hotspots where seniors could easily acquire the virus, killing many.
Connecticut, however, could be an exception. In 2019, the Connecticut General Assembly introduced H.B. 5861, a bill that would prohibit health insurers from using QALYs as a threshold to determine patient coverage. In January of 2021, Connecticut State Rep. Michelle Cook (D-Torrington) reintroduced the bill (H.B. 6242), representing the desire to reject discriminatory practices such as the QALY. Connecticut has taken these important first steps to protect vulnerable populations, but more work is needed to ultimately do so.
Progressive states where governments are more and more involved in healthcare decisions are coming to resemble the nationalized healthcare systems in Europe and Canada where, it is said, the healthcare is great – unless you are sick and a bureaucrat rules that you are not eligible for treatment.
Connecticut, Massachusetts, and New York are centers of great medical expertise and scientific knowledge, but Oklahoma is where you will find sound healthcare policy. Connecticut could join that list by becoming the next state to prohibit the use of QALY.
William Smith, Ph.D., is Visiting Fellow in Life Sciences at Pioneer Institute in Boston.