Hypocrisy Exposed by Mindless Bureaucracy in COVID-19 Responses and the Quality Adjusted Life Years Methodology

Life or death circumstances can bring out the best in people or the worst in people. They definitely expose the hypocrisy in people. The COVID-19 crisis has done this in spades. And we have an example playing out in Oklahoma right now with a bill that has gone to Governor Stitt for signature.

That bill, HB 2587, would require implementation of safeguards against state health agencies that would use purely economic calculations to justify withholding life-sustaining or quality-of-life-improving care from the old and profoundly disabled. It’s a response to a methodology called Quality Adjusted Life Years in which the cost of medication is compared to supposed benefit for patients. Since older people have fewer years to live, and might not even be apparently productive, this methodology would deny such individuals at least some medications.

Quality Adjusted Life Years is the sort of methodology described in the Obamacare Act that gave rise to the claim of some opponents that Obamacare created “death panels.” It is a fact that we spend a lot of money in this country, much of it through Medicare, using extraordinary measures to keep people near life’s end alive for a few more months. It’s the sort of thing family members insist on when they do not have to bear the cost of their decision to “save the life” of someone in their 90s (as one old, retired doctor says, “Ain’t nobody gettin’ out of this mess alive”). Some would argue such a methodology is necessary in order to counteract the incentives inherent in “free” health care, and they’re not entirely wrong to do so.

But this is where the hypocrisy comes in. COVID-19 mostly targets old people. In fact, recently it was reported that 28,000 people have died from the virus who lived and worked just in New York nursing homes alone. At the time the number was reported, it represented a third of all deaths in the United States. Meanwhile, just a few days ago, worldwide, no children (right, none) aged 0-9 had died from COVID-19. Only nine aged 0-17 (presumably, really 10-17) had died in New York.

When you consider the death rate, even among the aged, it is truly amazing that we have shut down WHOLE economies in an effort to save the lives of a tiny proportion of our population, most of them aged, unhealthy, and near the end of their lives. Those who argue for the shutdowns, and keeping them going for months, regardless of the economic cost, tend to be left-of-center in their political beliefs. It’s the left-of-center who also seem to be all for withholding medications to people near the end of their lives. On the one hand, they’re willing to trade lots of children’s lives (lost due to economic decline) to mostly save the lives of relatively few old people; on the other hand, they’re willing to do nothing to save the lives of old people when they’re told not to by a bureaucratic, mathematical calculation.

Meanwhile, right-of-center individuals like us have been rather upset that so little has been done to inform the public of who was truly at risk from COVID-19. Governor Cuomo forced nursing homes to take COVID-positive patients, almost intentionally seeding the most vulnerable with the virus. Many of our nation’s leaders have been acting as if everyone is equally at risk, blinding the general public to prudent actions to protect the truly COVID-19 vulnerable, and taking actions (shutting economies) that are truly deadly to the economically vulnerable. It’s as if lefty-leaning politicians have done all they can to kill as many people as possible while simultaneously claiming to save lives.

This is the truly scary thing about this Quality Adjusted Life Years methodology. It sounds like it’s putting cold, dispassionate, objective, and economically-derived mathematics in charge of decisions whether to administer expensive life-saving or life-enhancing drugs, but it’s really putting bureaucrats with who-knows-what sort of agendas in charge of life decisions.

Maybe we just have to live with the ridiculously expensive consequences of free health care for the sickest demographic group in our population in order to maintain our humanity and morality. Maybe instead of trying to counteract the incentives inherent in free health care with mathematical edicts from on high, we should enact different policies and stop giving away health care almost entirely for free in the first place. After all, it’s not really free. And after all, that’s the only way to put people – family and loved ones – who can best weigh the costs against the benefits and the right versus the wrong in charge of end-of-life decisions.

So as strange as it may sound coming from someone who is all about being responsible with taxpayers’ money, it might just be that leaders who hope to stand before God someday with anything like a clear conscience have little choice but to support bills like HB 2587.

Byron Schlomach is 1889 Institute Director and can be contacted at bschlomach@1889institute.org. 

The opinions expressed in this blog are those of the author, and do not necessarily reflect the official position of 1889 Institute.