There Is More to Life than Death.

• Author: Singleton, Marilyn M.
• Position: MEDICINE AND HEALTH

ONE Patient Protection and Affordable Care Act program to promote "quality care" through financial incentives for attaining high performance scores (and penalties for low scores) contains a metric that is fraught with moral hazard. Hospitals with higher numbers of pneumonia, heart failure, or heart attack patients who die within 30 days of discharge receive a lower score. However, if patients are designated for hospice (palliative) care during the first 24 hours of their hospital stay, and then die within 30 days of discharge, they are not counted against the hospital's score. In order to improve its quality-of-care score, one Veterans Administration hospital disclosed that it used an "inappropriate admissions system" where sicker patients were turned away against the physicians' recommendations.

As PPACA continues its painful death, many are seduced by the promises of government-sponsored single-payer health care. Given the Federal government's 2017 health-care expenditures of 1.14 trillion dollars, politicians and policymakers ponder how to pay for such a massive program. Patients wonder whether they will pay with their pocketbooks (taxes) or their lives (rationing).

The fallback solution of raising everyone's taxes is unpalatable to most. Aware that providing fewer services saves money but fearing public outrage, politicians have shunned efforts to explicitly ration health. Thus, policymakers promote programs that reduce waste and inefficiency. For instance, frugality is encouraged by reimbursing a set dollar amount for a course of treatment that includes all inpatient and outpatient care and physician fees ("bundling"). However, once the waste and inefficiency successfully are addressed, what is the next step to rein in "overuse" of services?

The British National Health Service's National Institute for Health and Care Excellence supports the use of "quality-adjusted life years" (QALY) to measure the quality and quantity of life added due to a particular medical treatment. One QALY is one year of perfect health. Zero QALY is death. If the cost per QALY gained exceeds a predetermined amount, the government denies payment for that treatment. Touted as more ethical, the "Complete Lives System"--the brainchild of ObamaCare physician architect Ezekiel Emanuel--includes worrisome determinants of who should receive care. The system prioritizes adolescents and persons with "instrumental value," i.e., individuals with "future usefulness."

These...