What is six months of your life worth? And don't say priceless. It's not priceless. Not if you're not paying. So let's sharpen the question: What should six months of your life be worth to your insurer, be that insurer the government or Aetna? Which is another way of saying, what should the rest of us be willing to pay to keep you alive for six months? And keep in mind that whatever six months of your life is worth, that's what six months of everyone's life is worth. So what's the number? $10,000? $30,000? $50,000? $1,000,000? $10,000,000? People often compare American health care to Canadian health care. It's the wrong comparison. The inverse of the American health care system is the British health care system. Where we are the priciest, they are the cheapest. We refuse to make any explicit decisions, instead denying care based on criteria that makes the denial the fault of the patient rather than the system. You don't have enough money for the treatment. They make all their decisions explicit, relying on criteria that makes the denial the fault of the system's judgments. We don't think that treatment worth the cost. Their system gives patients someone to be angry at. Ours has no connection to value. Their system creates more blame, ours engenders more tragedy. What's at issue here is rationing. In 2006, adjusted for purchasing power, the United Kingdom spent $2,760 per person on health care. America spent $6,714. It's a difference of almost $4,000 per person, spread across the population. That's $4,000 that can go into wages, or schools, or defense, or luxury, or mortgage-backed securities. And there's no evidence that Britain's aggregate outcomes are noticeable worse. But they do say "no" a lot more than we do. Their system refuses to pay high prices for medical technologies and pharmaceuticals that it judges insufficiently effective. They've forced themselves to make choice, because they have something we don't have: A global budget. They are willing to spend a certain number of dollars (well, pounds) on health care each year, and no more than that. If resources aren't unlimited, then choices need to be made. It's not quite correct to say that those choice will mean letting someone die, but they do mean putting limits on what we will spend to keep them alive. The New York Times has a front page story today on the British system of rationing. It's a long read, but an important one. And right up towards the top, you see why. The British system has made a choice. They have valued six months of life at $22,750. That's all they can afford, they say. So here's the question: In a government system in the US, should the government be on the hook for more than that? If six more months of life -- not a cure, but a six month reprieve-- would cost $50,000, should we pay for that, keeping in mind that that money is coming from priorities like education and food stamps and wages increases? Or should we have limits? Should the system itself ration? Related: The Health of Nations.
